1 00:00:03,360 --> 00:00:06,480 Speaker 1: I'm Alec Baldwin and you're listening to Here's the thing. 2 00:00:08,240 --> 00:00:13,600 Speaker 1: Democratic presidential primary already gives me a headache. Huge new 3 00:00:13,720 --> 00:00:18,239 Speaker 1: policy initiatives get announced almost weekly by every player on 4 00:00:18,280 --> 00:00:22,200 Speaker 1: a crowded field. It's a cacophony. The Family Act gives 5 00:00:22,200 --> 00:00:25,160 Speaker 1: you about sixty of your wages guaranteed. Families that are 6 00:00:25,200 --> 00:00:27,639 Speaker 1: making a hundred thousand dollars or less, we'll get up 7 00:00:27,680 --> 00:00:30,320 Speaker 1: to five hundred dollars a month, which because every child 8 00:00:30,480 --> 00:00:35,360 Speaker 1: in America a savings account. But all the major candidates 9 00:00:35,840 --> 00:00:40,560 Speaker 1: have spoken with one voice about one thing, universal healthcare. 10 00:00:41,640 --> 00:00:45,680 Speaker 1: Most have even endorsed Bernie Sanders Medicare for All bill, 11 00:00:46,200 --> 00:00:52,240 Speaker 1: similar to Canada's National insurance system. Sounds simple, at least 12 00:00:52,240 --> 00:00:56,560 Speaker 1: in theory, but as our President said, it's an unbelievably 13 00:00:56,640 --> 00:01:01,720 Speaker 1: complex subject. Nobody knew that health care could be so complicate. Indeed, 14 00:01:02,520 --> 00:01:05,240 Speaker 1: I needed someone to break it all down for me, 15 00:01:05,680 --> 00:01:10,080 Speaker 1: and the choice was obvious. Sarah Cliff of Vox is 16 00:01:10,120 --> 00:01:14,720 Speaker 1: the clearest, liveliest, most knowledgeable health care reporter out there. 17 00:01:15,319 --> 00:01:18,240 Speaker 1: Not only has she spent thousands of hours reading all 18 00:01:18,280 --> 00:01:23,160 Speaker 1: the major universal coverage proposals, really all of them, but 19 00:01:23,280 --> 00:01:28,800 Speaker 1: she studied foreign systems too, especially her native Canada, and 20 00:01:28,840 --> 00:01:33,479 Speaker 1: finally Cliff started out as a politics reporter. She gets 21 00:01:33,520 --> 00:01:36,920 Speaker 1: that even the best bill doesn't do sick, cash strapped 22 00:01:36,920 --> 00:01:39,960 Speaker 1: Americans any good if it's not calculated to get through 23 00:01:40,000 --> 00:01:44,480 Speaker 1: Congress and onto the President's desk. As a savvy observer 24 00:01:44,640 --> 00:01:48,160 Speaker 1: of politics, at one point, Sarah Cliff held out hope 25 00:01:48,320 --> 00:01:52,400 Speaker 1: that the current president, understanding his base, might be the 26 00:01:52,520 --> 00:01:57,000 Speaker 1: unlikely vehicle for reform. I remember the very start of 27 00:01:58,200 --> 00:01:59,680 Speaker 1: right when he's coming it off, as he gave this 28 00:01:59,760 --> 00:02:02,080 Speaker 1: inner view where he said he has a healthcare plan 29 00:02:02,120 --> 00:02:03,960 Speaker 1: and it's going to cover everybody, and like it's going 30 00:02:04,040 --> 00:02:05,800 Speaker 1: to be cheap and great. I remember I was up 31 00:02:05,800 --> 00:02:07,960 Speaker 1: on the Capitol and like all his healthcare reporters are like, oh, 32 00:02:08,000 --> 00:02:09,720 Speaker 1: maybe there's a plan, Like maybe he has a Like 33 00:02:09,800 --> 00:02:13,919 Speaker 1: there's never a plan. There just is not a plan. Now, 34 00:02:14,320 --> 00:02:18,560 Speaker 1: this is a topic so broad and so essential in 35 00:02:18,639 --> 00:02:21,239 Speaker 1: people's lives, and is uh, you know, always in the 36 00:02:21,320 --> 00:02:25,120 Speaker 1: top three of people's concerns politically during election cycles. What 37 00:02:25,200 --> 00:02:29,079 Speaker 1: are we going to do to revamp or to improve healthcare? 38 00:02:29,919 --> 00:02:32,320 Speaker 1: And in that conversation, and I want to keep this 39 00:02:32,440 --> 00:02:35,240 Speaker 1: on very Layman's terms for the time being, because because 40 00:02:35,240 --> 00:02:38,359 Speaker 1: because I'm a bit slow in this area, because people 41 00:02:38,400 --> 00:02:40,440 Speaker 1: will point to the Canadian model and say, just to 42 00:02:40,560 --> 00:02:43,560 Speaker 1: the north of US, Canada has this system. What does 43 00:02:43,639 --> 00:02:45,560 Speaker 1: the Canadian system look like to you? What do they 44 00:02:45,600 --> 00:02:48,880 Speaker 1: do and what don't they do? The Canadian system, I 45 00:02:49,000 --> 00:02:50,840 Speaker 1: see it as one of the most equal health care 46 00:02:50,919 --> 00:02:53,840 Speaker 1: systems in the world. So what they do, which is unique, 47 00:02:54,040 --> 00:02:57,200 Speaker 1: is they offer a government run healthcare plan to all 48 00:02:57,360 --> 00:03:00,639 Speaker 1: their residents with no charge when you go to the doctor. 49 00:03:01,120 --> 00:03:04,840 Speaker 1: And that is true for hospital visits, for doctor visits, 50 00:03:05,200 --> 00:03:10,639 Speaker 1: for kind of the base level medical benefits. And what 51 00:03:10,800 --> 00:03:12,640 Speaker 1: they do to kind of make that possible because it's 52 00:03:12,720 --> 00:03:15,359 Speaker 1: kind of expensive, right to give everyone healthcare with no 53 00:03:15,639 --> 00:03:17,799 Speaker 1: fees when you go to the doctor, they make it 54 00:03:17,840 --> 00:03:21,680 Speaker 1: a pretty limited benefit package. So there is not vision care, 55 00:03:22,040 --> 00:03:25,080 Speaker 1: there is not dental care. Prescription drugs actually aren't covered 56 00:03:25,080 --> 00:03:27,200 Speaker 1: in the Canadian system, which is now seen by Canadians 57 00:03:27,280 --> 00:03:30,560 Speaker 1: is a pretty big gap and something some Canadian politicians 58 00:03:30,600 --> 00:03:33,760 Speaker 1: are trying to fix. But what they really believe is 59 00:03:33,800 --> 00:03:37,000 Speaker 1: that for this core set of benefits, everyone rich, poor, 60 00:03:37,520 --> 00:03:39,480 Speaker 1: they should all have access to it. Nobody should be 61 00:03:39,520 --> 00:03:41,840 Speaker 1: paying when they go to the doctor, and they do 62 00:03:42,000 --> 00:03:43,920 Speaker 1: end up with slightly longer wait times as a result. 63 00:03:44,000 --> 00:03:46,680 Speaker 1: But most Canadians I've talked to about this, they're fine 64 00:03:46,720 --> 00:03:48,720 Speaker 1: with us as long as the rich Canadians and the 65 00:03:48,800 --> 00:03:50,800 Speaker 1: poor Canadians have to wait the same amount of time. 66 00:03:51,040 --> 00:03:53,960 Speaker 1: Right now. Now, when they were arguing about whether or 67 00:03:54,040 --> 00:03:55,400 Speaker 1: not to have this in because you can talk a 68 00:03:55,400 --> 00:03:56,680 Speaker 1: little bit from the history of it, how did it 69 00:03:56,720 --> 00:03:59,520 Speaker 1: come about, What was the argument that won the day, 70 00:03:59,680 --> 00:04:01,600 Speaker 1: How did they actually pull it off there that they 71 00:04:01,640 --> 00:04:04,400 Speaker 1: convinced that the government and the people of the country 72 00:04:04,440 --> 00:04:06,120 Speaker 1: that it was in their interest to pay for the 73 00:04:06,240 --> 00:04:09,160 Speaker 1: lion's share of their medical care. Yeah, so it's kind 74 00:04:09,200 --> 00:04:13,600 Speaker 1: of a wild story from Saskatchewan history, which most people 75 00:04:13,640 --> 00:04:17,760 Speaker 1: are not very versed. I'm dying it's the most exciting 76 00:04:17,800 --> 00:04:21,480 Speaker 1: Saskatchewan history you'll probably learn all day. So what happened, 77 00:04:21,520 --> 00:04:23,400 Speaker 1: and it really has some striking parallels to where we 78 00:04:23,440 --> 00:04:26,479 Speaker 1: are in the US right now. In the nineteen sixties, 79 00:04:26,720 --> 00:04:30,080 Speaker 1: there was a socialist running to be the premier, which 80 00:04:30,160 --> 00:04:32,560 Speaker 1: essentially the Canadian version of governor of Saskatchewan. This guy 81 00:04:32,640 --> 00:04:37,160 Speaker 1: named Tommy Douglas. Tommy Douglas was running on a healthcare platform. 82 00:04:37,560 --> 00:04:39,920 Speaker 1: He was running on the idea that healthcare should be 83 00:04:39,920 --> 00:04:42,440 Speaker 1: a human right Canada. You know, kind of at a 84 00:04:42,520 --> 00:04:45,120 Speaker 1: healthcare system, a more rudimentary version of what we have 85 00:04:45,920 --> 00:04:48,320 Speaker 1: right now. Women were providing care at home to the 86 00:04:48,360 --> 00:04:50,720 Speaker 1: best of their ability. There was kind of a makeshift 87 00:04:50,760 --> 00:04:53,840 Speaker 1: system of doctors. What Tommy Douglas really argued in his 88 00:04:54,000 --> 00:04:56,599 Speaker 1: campaign and the campaign that he won, was that health 89 00:04:56,640 --> 00:05:00,440 Speaker 1: care should be a right for all Saskatchewan residents. And 90 00:05:00,920 --> 00:05:03,400 Speaker 1: there's a lot of parallels with the Bernie Sanders campaign. 91 00:05:03,440 --> 00:05:05,840 Speaker 1: I think, you know, this is a socialist running to 92 00:05:05,880 --> 00:05:08,720 Speaker 1: be the first socialist premier in Canada. He wins, and 93 00:05:08,760 --> 00:05:11,359 Speaker 1: then he has to implement the thing. And in nineteen 94 00:05:11,480 --> 00:05:14,960 Speaker 1: sixty two, July one, nineteen sixty two, Saskatchewan becomes the 95 00:05:15,000 --> 00:05:18,800 Speaker 1: first universal health care system in North America provincially. So 96 00:05:18,920 --> 00:05:21,560 Speaker 1: now we're just looking at one province Canada, eleven provinces. 97 00:05:22,080 --> 00:05:24,880 Speaker 1: It is so similar to where we are now. Conservatives 98 00:05:24,920 --> 00:05:27,080 Speaker 1: making the argument that they don't want the government involved 99 00:05:27,120 --> 00:05:29,960 Speaker 1: in medicine, that they know best, that they're worried, you know, 100 00:05:30,040 --> 00:05:31,920 Speaker 1: that the government is going to choose what health care 101 00:05:31,960 --> 00:05:34,760 Speaker 1: you get, and one health care you don't and all 102 00:05:34,800 --> 00:05:37,920 Speaker 1: the doctors go on strike and Saskatchewan has to fly 103 00:05:38,120 --> 00:05:41,160 Speaker 1: in British doctors from the National Health Care Service to 104 00:05:41,240 --> 00:05:45,239 Speaker 1: staff their emergency rooms. It's pretty it's like a wild story. 105 00:05:46,080 --> 00:05:50,960 Speaker 1: And twenty three days so the doctor what end of 106 00:05:51,040 --> 00:05:53,640 Speaker 1: the strike is. They also fly in this mediator between 107 00:05:53,680 --> 00:05:58,600 Speaker 1: the Saskatchewan government and the Saskatchewan doctors and they get 108 00:05:58,640 --> 00:06:01,960 Speaker 1: a few concessions and is known as the Saskatoon Agreement, 109 00:06:02,360 --> 00:06:06,680 Speaker 1: settled on July twenty nine two. And what they agree 110 00:06:06,720 --> 00:06:08,920 Speaker 1: to is that doctors are allowed to opt out of 111 00:06:08,960 --> 00:06:10,920 Speaker 1: the system if they want that they don't have to 112 00:06:11,040 --> 00:06:14,159 Speaker 1: participate in government health insurance. They can just work privately. 113 00:06:14,320 --> 00:06:16,160 Speaker 1: But if they are going to work privately, they can't 114 00:06:16,160 --> 00:06:19,120 Speaker 1: accept government insurance. So it makes a big trade off. 115 00:06:19,640 --> 00:06:21,360 Speaker 1: The fees get raised a little bit, they get a 116 00:06:21,400 --> 00:06:23,560 Speaker 1: bit of a pay raise, and the doctors agree to 117 00:06:23,640 --> 00:06:27,560 Speaker 1: come back to work. And Tommy Douglas, the premier who 118 00:06:27,680 --> 00:06:29,719 Speaker 1: started all this is actually a bit of an icon 119 00:06:29,839 --> 00:06:33,400 Speaker 1: in Canada now. The CBC, the Canadian Broadcasting Corporation, in 120 00:06:33,440 --> 00:06:36,400 Speaker 1: two thousand four hosted this kind of odd television event 121 00:06:36,440 --> 00:06:38,120 Speaker 1: where they decided they would vote on like who was 122 00:06:38,160 --> 00:06:42,280 Speaker 1: the greatest Canadian and he was the winner. He was 123 00:06:42,400 --> 00:06:46,720 Speaker 1: voted in this like primetime special player. But right do 124 00:06:46,720 --> 00:06:51,960 Speaker 1: you think Wayne? Exactly? Um, So what happens after Saskatchewan 125 00:06:52,040 --> 00:06:56,600 Speaker 1: does national healthcare? You quickly see other provinces building their 126 00:06:56,600 --> 00:06:58,840 Speaker 1: own healthcare systems, to the point now that within a 127 00:06:58,920 --> 00:07:02,160 Speaker 1: decade or so, Canada had national healthcare. And they pay 128 00:07:02,240 --> 00:07:05,159 Speaker 1: for all this with tax revenue. So Canada has significantly 129 00:07:05,240 --> 00:07:09,359 Speaker 1: higher taxes than we do, and that money is federal 130 00:07:09,400 --> 00:07:12,080 Speaker 1: income taxes is what they're financing the whole system with. 131 00:07:13,360 --> 00:07:16,760 Speaker 1: When the agreement was made, when the mediator from the 132 00:07:16,800 --> 00:07:19,320 Speaker 1: British healthcare system comes in and mediates the whole thing 133 00:07:19,800 --> 00:07:22,600 Speaker 1: and they have what was that with the Saskatoon agree agreement? 134 00:07:22,680 --> 00:07:24,560 Speaker 1: What do you what do you think was said to 135 00:07:24,720 --> 00:07:27,080 Speaker 1: if you recall or what do you think finally convinced 136 00:07:27,120 --> 00:07:29,800 Speaker 1: them to support this idea? I mean, I think there 137 00:07:29,880 --> 00:07:32,080 Speaker 1: was decent political support. So you know, you do have 138 00:07:32,160 --> 00:07:34,320 Speaker 1: the doctor saying we don't want to involved in healthcare, 139 00:07:34,400 --> 00:07:36,360 Speaker 1: but you also have this premier who has run this 140 00:07:36,520 --> 00:07:40,520 Speaker 1: campaign promising universal healthcare. It's popular, you know, just in 141 00:07:40,600 --> 00:07:43,560 Speaker 1: the out played politically. I think they got outplayed. I 142 00:07:43,600 --> 00:07:46,400 Speaker 1: think they realized once they got three weeks into this strike, 143 00:07:46,520 --> 00:07:48,240 Speaker 1: you know, the government was not going to bend. They 144 00:07:48,320 --> 00:07:50,120 Speaker 1: kept saying, we'll come back to work if you don't 145 00:07:50,200 --> 00:07:52,840 Speaker 1: do this Medicare for All program, and the government just 146 00:07:52,920 --> 00:07:56,040 Speaker 1: said no, you know, and eventually the doctors needed a job, right, 147 00:07:56,120 --> 00:07:58,280 Speaker 1: like you can only go out of work for so long. 148 00:07:58,400 --> 00:08:02,560 Speaker 1: They were like the air traffic controller exactly under. And 149 00:08:02,640 --> 00:08:04,960 Speaker 1: you actually see similar things from when Medicare launched in 150 00:08:05,040 --> 00:08:07,520 Speaker 1: nineteen sixty five in the US. You saw some hospitals 151 00:08:07,600 --> 00:08:10,520 Speaker 1: in the South, because of some of the rules around 152 00:08:10,560 --> 00:08:12,360 Speaker 1: race that you had to treat patients of all race 153 00:08:12,360 --> 00:08:14,240 Speaker 1: if you were going to participate in the Medicare program. 154 00:08:14,640 --> 00:08:16,640 Speaker 1: You saw some hospitals in the South say, you know, well, 155 00:08:16,640 --> 00:08:19,520 Speaker 1: we're not going to take Medicare, and eventually they caved 156 00:08:19,520 --> 00:08:21,920 Speaker 1: because the government has a pretty powerful tool, right, They're 157 00:08:21,960 --> 00:08:24,600 Speaker 1: going to pay you a lot of money to cover 158 00:08:24,720 --> 00:08:29,440 Speaker 1: healthcare bills. Usually we've seen historically healthcare providers come around 159 00:08:29,520 --> 00:08:31,520 Speaker 1: and accept that money. Why do you think the same 160 00:08:31,560 --> 00:08:34,200 Speaker 1: thing hasn't happened here. We've never actually seen a state 161 00:08:34,559 --> 00:08:37,120 Speaker 1: try and do single payer in the United States. We've 162 00:08:37,120 --> 00:08:39,760 Speaker 1: never seen a state get as far as Saskatchewan did, 163 00:08:40,280 --> 00:08:42,080 Speaker 1: and I think part of that might be the lobbying 164 00:08:42,120 --> 00:08:45,760 Speaker 1: that happens even before you get that far. So I think, 165 00:08:46,080 --> 00:08:48,079 Speaker 1: you know, you haven't seen legislators be willing to go 166 00:08:49,000 --> 00:08:51,480 Speaker 1: far enough. You know, you did see Medicare and acted, 167 00:08:51,520 --> 00:08:53,520 Speaker 1: and that was a big step in nineteen sixty five 168 00:08:53,600 --> 00:08:56,280 Speaker 1: when the government created Medicare for the elderly Medicaid for 169 00:08:56,360 --> 00:08:58,800 Speaker 1: the poor, and that was something the a m A, 170 00:08:58,880 --> 00:09:01,920 Speaker 1: the American Medical Association, and they opposed both of those programs, 171 00:09:01,960 --> 00:09:05,360 Speaker 1: which now are quite popular in the United States. So 172 00:09:05,480 --> 00:09:09,199 Speaker 1: the popularity is what silence is the medical community. I 173 00:09:09,280 --> 00:09:12,240 Speaker 1: think the popularity certainly makes it hard to lobby against them. 174 00:09:12,320 --> 00:09:14,040 Speaker 1: It's a lot I think would be very, very hard 175 00:09:14,120 --> 00:09:15,960 Speaker 1: for the A m A to launch a campaign today 176 00:09:16,040 --> 00:09:17,679 Speaker 1: is saying, you know, get rid of Medicare and go 177 00:09:17,800 --> 00:09:19,960 Speaker 1: back to the way it was. When you have millions 178 00:09:19,960 --> 00:09:22,880 Speaker 1: of Americans who are on Medicare, who like their Medicare plans, 179 00:09:23,000 --> 00:09:26,680 Speaker 1: that's a pretty tough sell. How long after the creation 180 00:09:26,960 --> 00:09:30,480 Speaker 1: of Medicare and Medicaid, both programs became the equivalent of 181 00:09:30,559 --> 00:09:33,520 Speaker 1: like settled law. They're not under any threat. They're there 182 00:09:33,600 --> 00:09:36,800 Speaker 1: to stay. I mean decades for Medicaid. I think medicaids 183 00:09:36,800 --> 00:09:40,000 Speaker 1: a pretty interesting example. So Medicaid covers low income Americans 184 00:09:40,120 --> 00:09:42,280 Speaker 1: and it's a state program, so your state has to 185 00:09:42,320 --> 00:09:45,400 Speaker 1: opt into it. In six five it's created. How many 186 00:09:45,440 --> 00:09:49,839 Speaker 1: states opt into it? Now all of them? But that 187 00:09:49,960 --> 00:09:51,719 Speaker 1: was not the case. Only about a dozen or so 188 00:09:51,880 --> 00:09:54,240 Speaker 1: states signed on at first because one of the things 189 00:09:54,280 --> 00:09:55,839 Speaker 1: the government said is, you know, we're going to pay 190 00:09:56,280 --> 00:09:58,480 Speaker 1: part of the medical bills, usually most of the medical bills, 191 00:09:58,520 --> 00:10:00,240 Speaker 1: but you're going to have to kick in some money too. 192 00:10:00,800 --> 00:10:05,000 Speaker 1: It wasn't until nine that all states participated in medicaid. 193 00:10:05,080 --> 00:10:08,280 Speaker 1: So we're talking about twenty four years from the start 194 00:10:08,320 --> 00:10:11,880 Speaker 1: of medicaid to universal medicaid in the US. We were 195 00:10:11,960 --> 00:10:15,000 Speaker 1: joking before we started recording with you that you were 196 00:10:15,040 --> 00:10:17,000 Speaker 1: given an assignment. You were like, oh God, not this, 197 00:10:17,679 --> 00:10:21,160 Speaker 1: And now years later you're an expert in this field. Yes, 198 00:10:21,240 --> 00:10:24,880 Speaker 1: it was a little bit of happenstance. My first job 199 00:10:25,040 --> 00:10:27,319 Speaker 1: was at Newsweek magazine here in New York, and I 200 00:10:27,400 --> 00:10:31,240 Speaker 1: was an intern there um in right around when President 201 00:10:31,320 --> 00:10:34,360 Speaker 1: Obama was making his first run for office, and I 202 00:10:34,440 --> 00:10:37,320 Speaker 1: was on the politics team. The election died down. There 203 00:10:37,320 --> 00:10:38,880 Speaker 1: are too many people on politics and I got moved 204 00:10:38,920 --> 00:10:41,800 Speaker 1: to healthcare and this healthcare debate was starting up in 205 00:10:41,920 --> 00:10:44,480 Speaker 1: d C. So I kind of just raised my hand 206 00:10:45,040 --> 00:10:48,200 Speaker 1: to cover it, you know, not knowing that what thirteen 207 00:10:48,320 --> 00:10:51,200 Speaker 1: years later, I would still be writing about the same thing. 208 00:10:51,320 --> 00:10:53,720 Speaker 1: But I think what I really love about this topic 209 00:10:54,000 --> 00:10:57,480 Speaker 1: is that there's such an intersection between the policy decisions 210 00:10:57,520 --> 00:10:59,960 Speaker 1: that are made and the personal stories. Like you said, 211 00:11:00,040 --> 00:11:02,640 Speaker 1: this is such like a human topic. There's so much 212 00:11:02,679 --> 00:11:05,959 Speaker 1: at stake when people can or can't afford healthcare. A 213 00:11:06,040 --> 00:11:08,240 Speaker 1: lot of the work I do right now is around 214 00:11:08,280 --> 00:11:10,560 Speaker 1: healthcare pricing. You know, how much is charged for healthcare. 215 00:11:11,080 --> 00:11:13,319 Speaker 1: And we've made this decision as the United States not 216 00:11:13,480 --> 00:11:16,120 Speaker 1: to regulate our healthcare prices, and it's a very unusual 217 00:11:16,600 --> 00:11:19,079 Speaker 1: decision for a developed country to make. I talked to 218 00:11:19,120 --> 00:11:21,079 Speaker 1: a family in California who have a daughter with a 219 00:11:21,200 --> 00:11:24,520 Speaker 1: rare condition, and they were charged twenty dollars for an 220 00:11:24,600 --> 00:11:28,360 Speaker 1: m r I. Like that is an astronomical because Stanford 221 00:11:28,360 --> 00:11:31,360 Speaker 1: wanted to charge dollars for an m r I. Because 222 00:11:31,400 --> 00:11:33,760 Speaker 1: you can make a lot of money charging twenty dollars 223 00:11:33,800 --> 00:11:37,880 Speaker 1: for m r I. No one challenge them, nobody, no regulators, No, Well, 224 00:11:37,920 --> 00:11:40,760 Speaker 1: there's no regulator to challenge them in the US, You're 225 00:11:40,760 --> 00:11:42,840 Speaker 1: about to charge whatever they can get away with. Yeah, 226 00:11:43,000 --> 00:11:45,040 Speaker 1: so you know in this like in this particular case, 227 00:11:45,160 --> 00:11:47,000 Speaker 1: they needed to see a certain specialist who is there, 228 00:11:47,040 --> 00:11:48,640 Speaker 1: and the specially said, oh, let's take an m R I. 229 00:11:48,720 --> 00:11:50,559 Speaker 1: And they figured, you know, how much can an m 230 00:11:50,640 --> 00:11:52,679 Speaker 1: R I cost? Maybe a few thousand dollars. They weren't 231 00:11:52,720 --> 00:11:54,640 Speaker 1: warned by the person how much the m R I was, 232 00:11:54,760 --> 00:11:57,120 Speaker 1: and honestly, the person probably didn't know. One of the 233 00:11:57,120 --> 00:11:58,880 Speaker 1: things I hear a lot from doctors because I'm quite 234 00:11:58,920 --> 00:12:01,880 Speaker 1: critical of pricing that well, we're just trying to provide 235 00:12:01,920 --> 00:12:04,599 Speaker 1: the best care. We don't know the prices. And that 236 00:12:04,760 --> 00:12:06,679 Speaker 1: might be the case, but you know, not knowing the 237 00:12:06,720 --> 00:12:10,480 Speaker 1: prices has a huge effect on the patients. I think 238 00:12:10,520 --> 00:12:12,319 Speaker 1: sometimes when I talk to doctors, I feel like some 239 00:12:12,360 --> 00:12:14,559 Speaker 1: of their views are a little bit myopic, that their 240 00:12:14,600 --> 00:12:16,360 Speaker 1: focus is on, you know, we just need to provide 241 00:12:16,360 --> 00:12:17,959 Speaker 1: the best care and the patient's going to deal with 242 00:12:18,040 --> 00:12:20,920 Speaker 1: the bill later. Like the bill could be catastrophic for 243 00:12:21,040 --> 00:12:23,599 Speaker 1: this family. They're not poor, but this bill is a 244 00:12:23,760 --> 00:12:26,719 Speaker 1: quarter of their income for the entire year. And you know, 245 00:12:26,800 --> 00:12:29,520 Speaker 1: the hospital just kind of said well, that's that's our price, 246 00:12:29,840 --> 00:12:33,040 Speaker 1: and now they're stuck with it. Um. So, you know, 247 00:12:33,320 --> 00:12:36,200 Speaker 1: I really think it's such like an interesting, fascinating beat 248 00:12:36,240 --> 00:12:39,280 Speaker 1: where you can see the policy decisions being made in 249 00:12:39,360 --> 00:12:42,200 Speaker 1: d C, being made in state houses, of such personal 250 00:12:42,320 --> 00:12:44,679 Speaker 1: effects on all of us. It's so universal, you know, 251 00:12:44,800 --> 00:12:47,520 Speaker 1: no one gets stopped out of the healthcare system. Was it? 252 00:12:47,640 --> 00:12:51,760 Speaker 1: There was some neo sporing his daughter. He has like 253 00:12:51,800 --> 00:12:53,800 Speaker 1: a one year old, and she managed to tie a 254 00:12:53,840 --> 00:12:56,800 Speaker 1: piece of her hair around her toe really tightly, to 255 00:12:56,920 --> 00:12:58,599 Speaker 1: the point it was turning blue. He takes her to 256 00:12:58,640 --> 00:13:01,000 Speaker 1: the e R because it's the weekend. Everything else it's closed. 257 00:13:01,240 --> 00:13:03,000 Speaker 1: Turns out it's totally fine. They put the news boring 258 00:13:03,040 --> 00:13:05,520 Speaker 1: on it, head home. A few weeks later they get 259 00:13:05,520 --> 00:13:08,719 Speaker 1: a bill for six for this interaction. You know, I 260 00:13:08,840 --> 00:13:12,280 Speaker 1: think price transparency would be a start. You know. I 261 00:13:12,360 --> 00:13:16,640 Speaker 1: think who's opposed to that the hospitals, you know, because 262 00:13:16,840 --> 00:13:19,200 Speaker 1: it's it's a great system right for hospitals right now 263 00:13:19,280 --> 00:13:21,480 Speaker 1: where you can like take people who need care and 264 00:13:21,520 --> 00:13:24,760 Speaker 1: then build them whatever and the alley on the way home, 265 00:13:25,040 --> 00:13:30,000 Speaker 1: like that's a that's a system that really advantages hospitals. 266 00:13:30,160 --> 00:13:33,079 Speaker 1: The American Hospital Association. So what does the medical profession 267 00:13:33,160 --> 00:13:35,079 Speaker 1: itself say on the record of what kind of healthcare 268 00:13:35,120 --> 00:13:37,440 Speaker 1: they think the country should have. So I think they 269 00:13:37,679 --> 00:13:40,480 Speaker 1: generally I see them as aligning with the Hospital Association. 270 00:13:40,679 --> 00:13:42,800 Speaker 1: They are the people who are providing care pretty similar 271 00:13:42,840 --> 00:13:45,400 Speaker 1: to hospitals, so they want to be you know, they 272 00:13:45,960 --> 00:13:49,120 Speaker 1: generally support widespread access to care. They were supporters of 273 00:13:49,160 --> 00:13:51,880 Speaker 1: the Affordable Care Act and the expansion of coverage. They 274 00:13:51,920 --> 00:13:54,640 Speaker 1: also support, you know, pretty high they want to get, 275 00:13:55,160 --> 00:13:56,679 Speaker 1: you know, and this is where you get into you 276 00:13:56,760 --> 00:13:58,560 Speaker 1: you can frame it different ways. They want to get 277 00:13:58,600 --> 00:14:01,559 Speaker 1: what they say are reasonable rates for the services they provide. 278 00:14:01,960 --> 00:14:03,959 Speaker 1: If you're opposing them, if you're an insurance company, you're 279 00:14:03,960 --> 00:14:05,920 Speaker 1: going to say they want to get outrageous rates for 280 00:14:06,000 --> 00:14:09,440 Speaker 1: the care that they provide. But they generally support access 281 00:14:09,520 --> 00:14:12,280 Speaker 1: to care as long as they're getting paid the amount 282 00:14:12,280 --> 00:14:14,120 Speaker 1: they would like to get paid. And you know, I 283 00:14:14,160 --> 00:14:16,480 Speaker 1: will say it's hard to paint doctors with a broad 284 00:14:16,520 --> 00:14:19,680 Speaker 1: brush where you have an interesting split. There's been some 285 00:14:19,760 --> 00:14:22,400 Speaker 1: interesting research if you look at the political affiliations of doctors, 286 00:14:22,440 --> 00:14:26,280 Speaker 1: where you see primary care doctors, obstetricians generally lower paid 287 00:14:26,360 --> 00:14:29,480 Speaker 1: fields in medicine. They tend to lean more liberal, align 288 00:14:29,560 --> 00:14:33,560 Speaker 1: with the Democratic Party. Higher paid doctors and stusiologists. Radiologists 289 00:14:33,560 --> 00:14:35,840 Speaker 1: tend to be a lot more conservative. So I will say, 290 00:14:35,920 --> 00:14:37,760 Speaker 1: you know, there are doctors who support single payer. There 291 00:14:37,760 --> 00:14:40,240 Speaker 1: are doctor who oppose the Affordable Care Act, but generally 292 00:14:40,280 --> 00:14:43,040 Speaker 1: if you look at their lobby, they're okay with expanding 293 00:14:43,080 --> 00:14:45,560 Speaker 1: coverage as long as they're getting paid a decent amounts. Now, 294 00:14:45,680 --> 00:14:48,800 Speaker 1: in Canada, where there's this core of services that are 295 00:14:48,840 --> 00:14:51,480 Speaker 1: basic services that are covered by the government, you pay nothing. 296 00:14:52,160 --> 00:14:54,360 Speaker 1: Does the majority of the population then go out and 297 00:14:54,440 --> 00:14:56,960 Speaker 1: get a supplemental policy to cover the other side dental 298 00:14:57,040 --> 00:14:59,120 Speaker 1: and vision and so forth. They do about two thirds 299 00:14:59,160 --> 00:15:01,880 Speaker 1: of Canadian care some kind of supplemental policy. Also for 300 00:15:02,000 --> 00:15:03,920 Speaker 1: drugs too, is a major thing that people are buying 301 00:15:03,960 --> 00:15:06,840 Speaker 1: their policies for that often works actually pretty similar to 302 00:15:06,880 --> 00:15:09,320 Speaker 1: American insurance, where it's a benefit at work is that 303 00:15:09,360 --> 00:15:12,320 Speaker 1: your employer will offer a supplemental plan. One of the 304 00:15:12,320 --> 00:15:15,080 Speaker 1: things that's actually pretty unique about the Canadian healthcare system 305 00:15:15,640 --> 00:15:17,880 Speaker 1: is they won't let you buy duplicat of coverage. So 306 00:15:17,880 --> 00:15:20,360 Speaker 1: if you live in Britain, you also get your basic plan. 307 00:15:20,520 --> 00:15:23,760 Speaker 1: But let's say you want a private hospital room, or 308 00:15:23,880 --> 00:15:25,640 Speaker 1: you want to jump to the front of the line 309 00:15:25,680 --> 00:15:27,880 Speaker 1: for hip surgery, you can buy a private plan that 310 00:15:27,880 --> 00:15:30,560 Speaker 1: will give you those benefits. In Canada, they and it's 311 00:15:30,600 --> 00:15:33,240 Speaker 1: been the subject of Canadian court cases, they will not 312 00:15:33,360 --> 00:15:35,640 Speaker 1: allow that kind of duplicat of coverage because they think 313 00:15:35,680 --> 00:15:38,960 Speaker 1: it cuts against the equality of their system. So they 314 00:15:39,040 --> 00:15:40,920 Speaker 1: want to force you to standard line with everybody else, 315 00:15:40,960 --> 00:15:42,360 Speaker 1: even if you don't, even if you have the means. 316 00:15:43,040 --> 00:15:45,760 Speaker 1: So you have that description of the system in Canada. 317 00:15:45,920 --> 00:15:47,520 Speaker 1: We're gonna get to the US in a moment, talk 318 00:15:47,560 --> 00:15:50,800 Speaker 1: about the systems in in the UK. In the UK, 319 00:15:51,120 --> 00:15:52,760 Speaker 1: so they you know, in some ways it's a much 320 00:15:52,800 --> 00:15:56,480 Speaker 1: more public system. The hospitals, the doctors, many of them 321 00:15:56,520 --> 00:15:59,560 Speaker 1: are working for and owned by the government. So whereas 322 00:15:59,560 --> 00:16:02,800 Speaker 1: in Canada you have a public health plan with private 323 00:16:02,880 --> 00:16:05,720 Speaker 1: doctors and hospitals, in the UK you have a public 324 00:16:05,760 --> 00:16:09,960 Speaker 1: health plan and public doctors in hospital the government. Everyone's 325 00:16:09,960 --> 00:16:13,680 Speaker 1: on the payroll of the government. Pretty favorably. You know, 326 00:16:14,160 --> 00:16:16,720 Speaker 1: Brits are pretty proud of their system. If you look 327 00:16:16,720 --> 00:16:19,400 Speaker 1: at international rankings. The Commonwealth Fund, which is a really 328 00:16:19,480 --> 00:16:22,480 Speaker 1: respected healthcare nonprofit, they rank the British one above the 329 00:16:22,520 --> 00:16:25,240 Speaker 1: Canadian one. But you know, I think what's interesting is 330 00:16:25,320 --> 00:16:28,120 Speaker 1: even though Britain is such a public system, you also 331 00:16:28,160 --> 00:16:30,600 Speaker 1: about ten percent of Brits who are buying this duplicate 332 00:16:30,680 --> 00:16:32,760 Speaker 1: of coverage to you know, get to the frontal line, 333 00:16:33,200 --> 00:16:36,960 Speaker 1: get their private room that they do allow insurance to 334 00:16:37,160 --> 00:16:38,800 Speaker 1: compete with their plan. And they think of it as 335 00:16:38,800 --> 00:16:41,280 Speaker 1: like a safety valve, like letting people out of the 336 00:16:41,360 --> 00:16:44,520 Speaker 1: system into the private system. That frees up some of 337 00:16:44,560 --> 00:16:46,760 Speaker 1: the public doctors for lower income people, and it lets 338 00:16:46,800 --> 00:16:49,520 Speaker 1: the people who want to buy their way duplicative are 339 00:16:51,440 --> 00:16:54,120 Speaker 1: you know, I don't know if I would say a supporter, 340 00:16:54,200 --> 00:16:56,160 Speaker 1: I think it's a more realistic system for the US. 341 00:16:56,280 --> 00:16:58,560 Speaker 1: I think, you know, we have a system where high 342 00:16:58,600 --> 00:17:00,960 Speaker 1: income people are very used to being able to buy 343 00:17:01,000 --> 00:17:03,000 Speaker 1: the care that they want to buy, and why shouldn't 344 00:17:03,040 --> 00:17:05,440 Speaker 1: they you know, in Canada, they would argue, because your 345 00:17:05,440 --> 00:17:07,479 Speaker 1: access to health care shouldn't depend on if you're rich 346 00:17:07,560 --> 00:17:09,639 Speaker 1: and poor, and you know, if there's a baseline of 347 00:17:09,720 --> 00:17:12,040 Speaker 1: healthcare that's paid for with the public dollar for them, 348 00:17:12,480 --> 00:17:14,920 Speaker 1: why would you condemn other people who could have better 349 00:17:15,160 --> 00:17:18,040 Speaker 1: healthcare because you'd worry about that private system of writing 350 00:17:18,080 --> 00:17:19,760 Speaker 1: the public system. So Let's say you know, in the 351 00:17:19,800 --> 00:17:22,640 Speaker 1: private system, doctors are earning more, they like it better, 352 00:17:22,720 --> 00:17:24,920 Speaker 1: they just stop seeing public patients and they create a 353 00:17:24,920 --> 00:17:27,240 Speaker 1: practice where the well, you didn't allow that, you said 354 00:17:27,280 --> 00:17:29,000 Speaker 1: you have to do both. So I think it gets 355 00:17:29,040 --> 00:17:32,040 Speaker 1: to like some core philosophical differences between like the UK 356 00:17:32,320 --> 00:17:34,520 Speaker 1: and Canada, Whereas Canada, you know, at the core of 357 00:17:34,560 --> 00:17:36,800 Speaker 1: their system, they just don't think money should buy you 358 00:17:36,880 --> 00:17:38,520 Speaker 1: better health and where everyone to be in pain at 359 00:17:38,520 --> 00:17:40,600 Speaker 1: the same time, want everyone poor and rich to be 360 00:17:40,720 --> 00:17:43,000 Speaker 1: in pain and get better at the exact same time. Like, 361 00:17:43,080 --> 00:17:46,119 Speaker 1: there's this great quote and um tr read he's a 362 00:17:46,160 --> 00:17:49,440 Speaker 1: fantastic journalist. He wrote this book, like he um. I 363 00:17:49,440 --> 00:17:51,240 Speaker 1: think he's a freelance journalist now, but he used to 364 00:17:51,240 --> 00:17:53,000 Speaker 1: write for the Washington Post. And he wrote a book 365 00:17:53,040 --> 00:17:57,160 Speaker 1: in twenty comparing um It's called Getting Better, Comparing Different 366 00:17:57,200 --> 00:17:59,320 Speaker 1: Healthcare Systems. And he's a fantastic quote in it that 367 00:17:59,359 --> 00:18:01,760 Speaker 1: I've always loved. I feel like it summarizes the Canadian 368 00:18:01,760 --> 00:18:05,200 Speaker 1: healthcare system better than anything else. Someone told him Canadians 369 00:18:05,320 --> 00:18:07,600 Speaker 1: don't mind waiting in line for healthcare as long as 370 00:18:07,600 --> 00:18:09,720 Speaker 1: they know the rich Canadians and the poor Canadians are 371 00:18:09,760 --> 00:18:12,320 Speaker 1: waiting the exact same amount of time. I think Australia 372 00:18:12,359 --> 00:18:16,159 Speaker 1: has a fascinating healthcare system, so they, unlike Canada, they 373 00:18:16,240 --> 00:18:18,720 Speaker 1: really encourage people to buy a private plan. So I 374 00:18:18,760 --> 00:18:21,040 Speaker 1: actually think, like the more I've learned about Australia system, 375 00:18:21,080 --> 00:18:24,760 Speaker 1: that they're a promising model for the US where because 376 00:18:24,840 --> 00:18:27,760 Speaker 1: they don't they they've run into challenges raising enough tax revenue. 377 00:18:28,160 --> 00:18:30,440 Speaker 1: They've decided to deal with that not by shrinking the 378 00:18:30,480 --> 00:18:33,840 Speaker 1: benefits or weights, but basically encouraging people to buy a 379 00:18:33,920 --> 00:18:36,200 Speaker 1: private plan that is competing against their own plan, which 380 00:18:36,240 --> 00:18:39,880 Speaker 1: feels like a much more American version of a healthcare system. 381 00:18:40,480 --> 00:18:43,720 Speaker 1: So this issue in this country obviously appears to be 382 00:18:43,800 --> 00:18:47,200 Speaker 1: a very partisan issue. Are there any Republicans that you 383 00:18:47,400 --> 00:18:48,960 Speaker 1: can name off the top of your head where you 384 00:18:49,040 --> 00:18:53,520 Speaker 1: think are strong on good reforms in healthcare. I think 385 00:18:53,560 --> 00:18:56,479 Speaker 1: a lot of Republican voters are interested in Medicare for all. 386 00:18:56,640 --> 00:18:58,080 Speaker 1: That's one of the things that surprised me. I was 387 00:18:58,080 --> 00:19:01,159 Speaker 1: actually doing some reporting and this area of Kentucky that 388 00:19:01,240 --> 00:19:05,080 Speaker 1: went for Trump, but also it's a ton of Obamacare enrollment, 389 00:19:05,200 --> 00:19:06,880 Speaker 1: you know, as reporting on why did all these Obamacare 390 00:19:07,000 --> 00:19:09,439 Speaker 1: rallies vote for Trump? And I wasn't there to talk 391 00:19:09,440 --> 00:19:11,000 Speaker 1: about Medicare for all, but one of the things that 392 00:19:11,040 --> 00:19:14,440 Speaker 1: came up multiple times from Republican voters was I wish 393 00:19:14,520 --> 00:19:16,520 Speaker 1: we could have a system like Canada's, you know. And 394 00:19:16,560 --> 00:19:19,080 Speaker 1: these are people who you know, supported President Trump, knew 395 00:19:19,160 --> 00:19:21,440 Speaker 1: he wanted to repeal the Affordable Care Act, telling me 396 00:19:21,520 --> 00:19:24,520 Speaker 1: they like Canada's healthcare system. And I think this is 397 00:19:24,560 --> 00:19:26,040 Speaker 1: a place where you see a bit of a divide 398 00:19:26,080 --> 00:19:28,960 Speaker 1: between legislators and like the Republican base and how they 399 00:19:29,000 --> 00:19:35,520 Speaker 1: think about healthcare. That was healthcare guru Sarah cliff a Vox. 400 00:19:36,119 --> 00:19:39,040 Speaker 1: If you want to hear Bernie Sanders ideas straight from 401 00:19:39,080 --> 00:19:42,960 Speaker 1: the horse's mouth. Here's the thing, as you covered, what 402 00:19:43,200 --> 00:19:45,200 Speaker 1: is the function of an insurance company. It's not to 403 00:19:45,320 --> 00:19:47,480 Speaker 1: provide quality care to of course the effect, the ways 404 00:19:47,560 --> 00:19:51,720 Speaker 1: to make as much money as they possibly can. And um, 405 00:19:52,240 --> 00:19:55,760 Speaker 1: you know what I think makes sense to me is 406 00:19:56,080 --> 00:20:00,240 Speaker 1: we have right now a fairly popular successful program, cold Care. 407 00:20:00,600 --> 00:20:03,280 Speaker 1: It works pretty well for people sixty years of age old. 408 00:20:03,560 --> 00:20:07,040 Speaker 1: Why not expand it to everybody? Here's the thing. Dot 409 00:20:07,200 --> 00:20:09,920 Speaker 1: org is where you can find my whole interview with 410 00:20:10,000 --> 00:20:14,560 Speaker 1: Bernie Sanders, now a declared candidate for the Democratic nomination 411 00:20:14,640 --> 00:20:29,560 Speaker 1: to the presidency. In this is Alec Baldwin and you're 412 00:20:29,640 --> 00:20:33,600 Speaker 1: listening to here's the thing. Sarah Cliff cut her Healthcare 413 00:20:33,720 --> 00:20:38,000 Speaker 1: reporting Teeth covering the two thousand nine debate over Obamacare 414 00:20:38,160 --> 00:20:42,720 Speaker 1: for Newsweek. I wanted to understand what Republican objections to 415 00:20:42,800 --> 00:20:45,879 Speaker 1: the policy had been back then. That is going to be, 416 00:20:46,040 --> 00:20:48,840 Speaker 1: you know, government takeover of healthcare, that the government was 417 00:20:48,880 --> 00:20:51,120 Speaker 1: going to dictate which doctors you saw. I only talk 418 00:20:51,200 --> 00:20:53,760 Speaker 1: government takeover of health care to the idea that big 419 00:20:53,800 --> 00:20:57,000 Speaker 1: government is always bad and always leads to something ineffective. 420 00:20:57,040 --> 00:20:59,560 Speaker 1: And did they were there anybody who are taking any 421 00:20:59,600 --> 00:21:01,840 Speaker 1: specific reasons why they thought it was better? I think. 422 00:21:02,000 --> 00:21:04,199 Speaker 1: I think the more thoughtful critique that I saw from 423 00:21:04,200 --> 00:21:06,840 Speaker 1: Republican legislators is that one of the things Obamacare was 424 00:21:06,840 --> 00:21:09,640 Speaker 1: going to do. It was going to require health insurance 425 00:21:09,640 --> 00:21:12,120 Speaker 1: plans to cover a wide array of benefits, so something 426 00:21:12,200 --> 00:21:14,920 Speaker 1: like maternity care, for example. Usually in the individual market 427 00:21:15,040 --> 00:21:19,120 Speaker 1: before Obamacare, health insurance just would not cover pregnancy because 428 00:21:19,160 --> 00:21:21,840 Speaker 1: pregnancy is expensive, so that would just be a benefit 429 00:21:21,920 --> 00:21:23,920 Speaker 1: that would not be included in your package. One of 430 00:21:23,960 --> 00:21:25,840 Speaker 1: the things Obamacare would do, and this is along with 431 00:21:25,880 --> 00:21:28,919 Speaker 1: like prescription drugs and mental health services. It told insurance companies, 432 00:21:28,960 --> 00:21:32,280 Speaker 1: you have to cover this wide suite of benefits. I 433 00:21:32,400 --> 00:21:35,040 Speaker 1: heard conservatives making the argument, you know, people should be 434 00:21:35,119 --> 00:21:37,639 Speaker 1: free to choose. They should be free to choose a cheaper, 435 00:21:37,760 --> 00:21:42,119 Speaker 1: skimpier health insurance plan and have that cheaper coverage, and 436 00:21:42,560 --> 00:21:45,000 Speaker 1: not everyone should be forced into these larger plans. So 437 00:21:45,040 --> 00:21:47,119 Speaker 1: it's a bit of like a philosophical difference I think 438 00:21:47,160 --> 00:21:50,719 Speaker 1: about healthcare right, like, whether we think, because we're all 439 00:21:50,800 --> 00:21:53,760 Speaker 1: members of society and we all participate in healthcare, we 440 00:21:53,840 --> 00:21:56,400 Speaker 1: should be required to purchase coverage for this wide suite 441 00:21:56,440 --> 00:21:59,199 Speaker 1: of benefits, or if we should give people the option 442 00:21:59,320 --> 00:22:02,080 Speaker 1: to buy these skimpier plans that often, you know, leave 443 00:22:02,119 --> 00:22:04,560 Speaker 1: people a little flat footed when they actually do need 444 00:22:04,600 --> 00:22:06,560 Speaker 1: to go to the doctor. I think that was a 445 00:22:07,200 --> 00:22:10,720 Speaker 1: key actual divide and how the two parties thought about policy. 446 00:22:11,000 --> 00:22:13,359 Speaker 1: So do you think that there's some sense to that, 447 00:22:13,440 --> 00:22:15,880 Speaker 1: which is that we should give people some choice. It's 448 00:22:16,000 --> 00:22:18,560 Speaker 1: it's hard, right because if you leave out maternity care, 449 00:22:18,640 --> 00:22:21,000 Speaker 1: you know, that puts the entire cost on anyone who's 450 00:22:21,000 --> 00:22:22,600 Speaker 1: going to have a baby. The whole point of health 451 00:22:22,640 --> 00:22:24,800 Speaker 1: insurance is to spread our healthcare costs out among a 452 00:22:24,880 --> 00:22:27,480 Speaker 1: wide group of people, so that it's roughly affordable for 453 00:22:27,600 --> 00:22:29,320 Speaker 1: all of us. You know, even when you know, I 454 00:22:29,400 --> 00:22:31,840 Speaker 1: had a baby last year, that's being spread out among 455 00:22:31,880 --> 00:22:33,680 Speaker 1: my health insurance plans, and the years I don't have 456 00:22:33,720 --> 00:22:35,680 Speaker 1: a baby, I'm kind of contributing to the other people 457 00:22:36,080 --> 00:22:39,960 Speaker 1: having kids. It's really hard to let someone opt out 458 00:22:40,080 --> 00:22:43,240 Speaker 1: and have a health insurance system still work, you know. 459 00:22:43,400 --> 00:22:45,080 Speaker 1: That being said, you know, one thing the Affordable Care 460 00:22:45,119 --> 00:22:48,760 Speaker 1: Act did is it did let younger people purchase catastrophic coverage, 461 00:22:48,800 --> 00:22:52,240 Speaker 1: you know, coverage that paid for a smaller boundaryr benefits 462 00:22:52,320 --> 00:22:53,760 Speaker 1: essentially like if you get hit by a bus, it 463 00:22:53,920 --> 00:22:55,960 Speaker 1: kicks in, but you know, and that went up to 464 00:22:56,040 --> 00:22:58,840 Speaker 1: age thirty under the Affordable Care Act. Republicans would have 465 00:22:58,880 --> 00:23:01,960 Speaker 1: liked to let everyone by catastrophic coverage, but it's a 466 00:23:02,040 --> 00:23:05,160 Speaker 1: big trade off. You really disadvantage when you let healthy 467 00:23:05,200 --> 00:23:07,520 Speaker 1: people just you know, buy these skimpy plans. You're really 468 00:23:07,560 --> 00:23:10,280 Speaker 1: going to disadvantage the sicker people who need well. It 469 00:23:10,320 --> 00:23:12,640 Speaker 1: becomes power, like you either in it or you're out 470 00:23:13,119 --> 00:23:15,760 Speaker 1: right yeah, I mean, Democrats didn't like the individual mandate 471 00:23:15,920 --> 00:23:19,280 Speaker 1: was an incredibly unpopular policy, but The whole reason they 472 00:23:19,320 --> 00:23:21,320 Speaker 1: included it is because if you are going to make 473 00:23:21,320 --> 00:23:23,880 Speaker 1: an insurance system work, you need a lot of people 474 00:23:23,920 --> 00:23:25,440 Speaker 1: buying in. You need the sick people, you need the 475 00:23:25,480 --> 00:23:28,680 Speaker 1: healthy people. And when you have an array of options, 476 00:23:28,760 --> 00:23:31,160 Speaker 1: when you have like the skimpy plan and the robust plan, 477 00:23:31,680 --> 00:23:33,600 Speaker 1: the healthy people by the skimpy plans, they don't use 478 00:23:33,680 --> 00:23:37,000 Speaker 1: much healthcare, the you know, sick people by the expensive 479 00:23:37,000 --> 00:23:39,200 Speaker 1: plan with lots of benefits, and the insurance market, you know, 480 00:23:39,320 --> 00:23:42,960 Speaker 1: essentially breaks down a little. You need the healthy people 481 00:23:43,040 --> 00:23:46,240 Speaker 1: subsidizing the sick people in order to make things work. 482 00:23:46,480 --> 00:23:50,720 Speaker 1: But where, and just philosophically, when we'll government and society say, 483 00:23:51,080 --> 00:23:54,120 Speaker 1: hey man, your forty pounds were more overweight, and you're 484 00:23:54,200 --> 00:23:58,280 Speaker 1: over fifty, and your cardiac cat scans at the following metrics. 485 00:23:58,359 --> 00:24:01,240 Speaker 1: To us, your your insurance gonna go way up. Maybe 486 00:24:01,280 --> 00:24:04,480 Speaker 1: you can smoke right right now, they're saying, when you 487 00:24:04,560 --> 00:24:06,560 Speaker 1: get a discount, if you don't smoke, you get a 488 00:24:06,560 --> 00:24:08,760 Speaker 1: preferred rate. If you don't smoke. When are we gonna 489 00:24:08,760 --> 00:24:11,320 Speaker 1: start to hand people the bill for their bad behavior? 490 00:24:11,359 --> 00:24:13,119 Speaker 1: Do you ever see any countries to do that? Well? 491 00:24:13,160 --> 00:24:15,560 Speaker 1: In the Affordable Care Act actually under Obamacare. If you're 492 00:24:15,560 --> 00:24:18,240 Speaker 1: buying an Obamacare plan, there is a question about whether 493 00:24:18,280 --> 00:24:19,680 Speaker 1: you smoke, and if you do, you're going to be 494 00:24:19,800 --> 00:24:22,800 Speaker 1: charged higher premiums. Um I don't know. I mean it's 495 00:24:22,840 --> 00:24:24,800 Speaker 1: like a checkbox you could check no and get the 496 00:24:24,880 --> 00:24:27,920 Speaker 1: cheaper premiums. I don't think anyone's really following up on that. 497 00:24:28,119 --> 00:24:29,359 Speaker 1: I mean one of the things you actually see a 498 00:24:29,400 --> 00:24:31,840 Speaker 1: lot doctors be obligated to report the fact that you 499 00:24:31,920 --> 00:24:33,520 Speaker 1: do that. They're your doctors and they know what you're 500 00:24:34,680 --> 00:24:37,080 Speaker 1: I don't know many people who smoke and line to 501 00:24:37,160 --> 00:24:39,480 Speaker 1: their doctor about that. Sure, yeah, I mean it gets 502 00:24:39,520 --> 00:24:41,800 Speaker 1: into some kind of tricky patient privacy issues or you 503 00:24:41,840 --> 00:24:44,040 Speaker 1: don't want your doctor. But you know, you see a 504 00:24:44,119 --> 00:24:47,000 Speaker 1: lot of corporate wellness programs and it's like kind of 505 00:24:47,040 --> 00:24:49,159 Speaker 1: these ideas if you participate in the wellness program and 506 00:24:49,240 --> 00:24:52,239 Speaker 1: like you meet certain wellness metrics, your company is going 507 00:24:52,280 --> 00:24:54,720 Speaker 1: to give you a discount on your health insurance, like 508 00:24:54,800 --> 00:24:57,200 Speaker 1: if you go to the gym or you know, sign 509 00:24:57,280 --> 00:24:58,840 Speaker 1: up for some kind of program. And I mean it's 510 00:24:58,880 --> 00:25:01,920 Speaker 1: like a tricky ray area. I don't know. I don't 511 00:25:01,960 --> 00:25:05,239 Speaker 1: know about how national healthcare systems are handling that right now, 512 00:25:05,359 --> 00:25:07,480 Speaker 1: but I think it's an issue that becomes a bigger one, 513 00:25:07,600 --> 00:25:09,399 Speaker 1: you know, as you see obesity rates going up, not 514 00:25:09,520 --> 00:25:11,240 Speaker 1: just here in the US but abroad, like that's a 515 00:25:11,840 --> 00:25:14,239 Speaker 1: difficult one to handle. But it seems to me now 516 00:25:14,400 --> 00:25:17,200 Speaker 1: that the inequity of healthcare and the way it plays 517 00:25:17,240 --> 00:25:20,240 Speaker 1: out now has broadened in the last twenty five years, 518 00:25:20,359 --> 00:25:22,480 Speaker 1: is it safe to say that that an increasing number 519 00:25:22,520 --> 00:25:25,920 Speaker 1: of people don't have adequate healthcare now? So you did 520 00:25:26,080 --> 00:25:28,800 Speaker 1: definitely see through the start of the Affordable Care Actor, 521 00:25:28,800 --> 00:25:31,280 Speaker 1: a rising number of people without health insurance. And I 522 00:25:31,320 --> 00:25:33,080 Speaker 1: think that largely has to do with the fact just 523 00:25:33,160 --> 00:25:36,560 Speaker 1: healthcare got really expensive that There's actually some great charts, 524 00:25:36,640 --> 00:25:38,280 Speaker 1: I know, they're great for audio, where they show like 525 00:25:38,359 --> 00:25:40,159 Speaker 1: our healthcare costs used to be in line with the 526 00:25:40,200 --> 00:25:43,480 Speaker 1: rest of the world through like the nineties or so, 527 00:25:44,000 --> 00:25:45,879 Speaker 1: and then in the nineties and these charts you just 528 00:25:45,920 --> 00:25:49,360 Speaker 1: see the US skyrocketing up, whereas like Canada, Netherlands, UK 529 00:25:49,960 --> 00:25:51,840 Speaker 1: are like growing at a reasonable rate of like three 530 00:25:51,920 --> 00:25:53,840 Speaker 1: or four percent a year, we start growing at seven 531 00:25:53,920 --> 00:25:57,200 Speaker 1: or eight percent a year. And as healthcare costs rise, 532 00:25:57,600 --> 00:26:01,560 Speaker 1: it's just harder for lower incompete boll to afford healthcare 533 00:26:01,640 --> 00:26:03,960 Speaker 1: so you see this growing gap between rich and poor. 534 00:26:04,400 --> 00:26:06,800 Speaker 1: You know, you don't see it for people over sixty 535 00:26:06,840 --> 00:26:08,959 Speaker 1: five because they're on the Medicaid program. So everyone has 536 00:26:08,960 --> 00:26:12,000 Speaker 1: access to healthcare once they get to sixty five. But 537 00:26:12,200 --> 00:26:14,920 Speaker 1: Medicaid has always been like a pretty restrictive program. It's 538 00:26:15,000 --> 00:26:17,640 Speaker 1: difficult to get on. It's limited to certain groups of people. 539 00:26:19,280 --> 00:26:21,600 Speaker 1: You have how many people just Medicaid service now? So 540 00:26:21,760 --> 00:26:25,719 Speaker 1: right now Medicaid actually services about sixty million Americans. It's 541 00:26:25,760 --> 00:26:28,600 Speaker 1: a really big chunk of the population. And it's actually 542 00:26:28,840 --> 00:26:32,240 Speaker 1: you know, the people who have gained health coverage under Obamacare, 543 00:26:32,359 --> 00:26:35,880 Speaker 1: most of them have gotten it through Medicaid. Before Obamacare. 544 00:26:36,240 --> 00:26:38,520 Speaker 1: To get on Medicaid, you had to be poor and something, 545 00:26:38,680 --> 00:26:41,240 Speaker 1: so like poor and a mom, or poor and disabled. 546 00:26:41,520 --> 00:26:43,520 Speaker 1: The Affordable Care Act said, you know, if you are 547 00:26:43,560 --> 00:26:46,040 Speaker 1: an individual, you earn less than fifteen thousand dollars a year, 548 00:26:46,359 --> 00:26:49,520 Speaker 1: there's no end. You just get Medicaid, um and that's 549 00:26:49,560 --> 00:26:52,200 Speaker 1: the law. Now that is the law, well, it's sort 550 00:26:52,240 --> 00:26:54,119 Speaker 1: of the law now. So the idea was this program 551 00:26:54,160 --> 00:26:56,119 Speaker 1: would exist in all fifty states, but we had a 552 00:26:56,160 --> 00:26:59,080 Speaker 1: Supreme Court decision in twenty eleven that said states get 553 00:26:59,160 --> 00:27:01,560 Speaker 1: to choose whether and not they want to participate in 554 00:27:01,680 --> 00:27:04,560 Speaker 1: Medicaid expansion. About two thirds of the states are participating, 555 00:27:04,920 --> 00:27:08,359 Speaker 1: but some really big states Texas Florida have big populations 556 00:27:08,400 --> 00:27:11,320 Speaker 1: of low income people who don't want to pay, and 557 00:27:11,359 --> 00:27:13,240 Speaker 1: they only have to pay ten percent. I would say, 558 00:27:13,320 --> 00:27:15,679 Speaker 1: you know, this is a really generous offer where they 559 00:27:15,680 --> 00:27:18,160 Speaker 1: don't have income taxes in those state or other mechanisms 560 00:27:18,200 --> 00:27:19,600 Speaker 1: to pay for and they want to keep it that way. 561 00:27:20,119 --> 00:27:22,280 Speaker 1: There is no income tax in Texas and Florida's if 562 00:27:22,280 --> 00:27:24,800 Speaker 1: iinder stand correctly, I think that's right. And you know 563 00:27:24,960 --> 00:27:26,880 Speaker 1: they don't want to raise in any case, they don't 564 00:27:26,880 --> 00:27:29,720 Speaker 1: want to raise the revenue to pay for those programs. 565 00:27:30,000 --> 00:27:32,680 Speaker 1: Um so. And that's really so. You see what the 566 00:27:32,720 --> 00:27:37,000 Speaker 1: Affordable Care Act coming into place in the uninsured rate drops, 567 00:27:37,040 --> 00:27:39,479 Speaker 1: more people are gaining coverage. Can you see these trends 568 00:27:39,560 --> 00:27:42,959 Speaker 1: of rising uninsured numbers reverse ever since Trump took office though, 569 00:27:42,960 --> 00:27:45,199 Speaker 1: you've seen a bit of a reversal where some even 570 00:27:45,240 --> 00:27:47,960 Speaker 1: though the Affordable Character is still standing law, some of 571 00:27:48,000 --> 00:27:50,600 Speaker 1: the decisions they've made seem to have, you know, led 572 00:27:50,680 --> 00:27:53,800 Speaker 1: to more people losing health insurance. So what are what 573 00:27:53,920 --> 00:27:57,320 Speaker 1: are the most evil things you've seen hospitals and insurance 574 00:27:57,359 --> 00:27:59,879 Speaker 1: companies do when you've been reporting on healthcare. Yeah, so 575 00:28:00,000 --> 00:28:02,680 Speaker 1: I'm gonna give you two from the emergency room space 576 00:28:02,680 --> 00:28:04,760 Speaker 1: because this year I've been doing this project on emergency 577 00:28:04,880 --> 00:28:06,760 Speaker 1: rooms where people have been sending me their e er bill. 578 00:28:06,840 --> 00:28:10,800 Speaker 1: So I read all sorts of horrific stories all day. Yes, 579 00:28:10,840 --> 00:28:13,359 Speaker 1: I've read about six d emergency or bills in the 580 00:28:13,440 --> 00:28:15,440 Speaker 1: last year. UM, And so two of the things that 581 00:28:15,480 --> 00:28:18,760 Speaker 1: jumped out of me. You you just click through the 582 00:28:19,640 --> 00:28:21,919 Speaker 1: you feel a little better about yourself when you're only 583 00:28:21,960 --> 00:28:24,919 Speaker 1: dealing with a hundred fifty bucks. So one is Zuckerberg 584 00:28:25,000 --> 00:28:28,280 Speaker 1: San Francisco General Hospital. So this is named for one 585 00:28:28,320 --> 00:28:30,280 Speaker 1: Facebook founder who donated a lot of money to the 586 00:28:30,320 --> 00:28:34,280 Speaker 1: public hospital. Um, they have made this really rare decision 587 00:28:34,880 --> 00:28:37,600 Speaker 1: to be out of network with all private health insurance. 588 00:28:38,040 --> 00:28:41,960 Speaker 1: They are also the only trauma center in San Francisco. 589 00:28:42,360 --> 00:28:44,680 Speaker 1: So if you have a trauma, if you fall from 590 00:28:44,720 --> 00:28:46,600 Speaker 1: a high height, if you are hit by a bus, 591 00:28:46,960 --> 00:28:49,000 Speaker 1: an ambulance is going to take you to San Francisco 592 00:28:49,080 --> 00:28:51,840 Speaker 1: General Hospital. And if you have private insurance, they are 593 00:28:51,920 --> 00:28:54,280 Speaker 1: not going to be in network with your health insurance. 594 00:28:54,320 --> 00:28:55,880 Speaker 1: So let me tell you like what patient I wrote 595 00:28:55,880 --> 00:28:58,520 Speaker 1: about there? Who know, this is just like a horrific story. 596 00:28:58,600 --> 00:29:00,600 Speaker 1: This is a guy named Justin who was walking on 597 00:29:00,640 --> 00:29:03,160 Speaker 1: the sidewalk and this pole hanging off the back of 598 00:29:03,200 --> 00:29:05,560 Speaker 1: a public bus hits him in the face and knocks 599 00:29:05,640 --> 00:29:08,120 Speaker 1: him unconscious. Next thing he knows, he wakes up at 600 00:29:08,120 --> 00:29:11,560 Speaker 1: San Francisco General. He has you know, severe concussion. He 601 00:29:11,840 --> 00:29:14,760 Speaker 1: has a laceration to the face. He also ends up 602 00:29:14,840 --> 00:29:17,520 Speaker 1: with a dollar bill. So this guy was hit by 603 00:29:17,520 --> 00:29:20,480 Speaker 1: a public bus, taken to the public hospital, the public 604 00:29:20,560 --> 00:29:24,720 Speaker 1: health bus. Yeah, like everything about this was so horrendous. 605 00:29:25,840 --> 00:29:27,560 Speaker 1: Grand What kind of treatment did he receive when he 606 00:29:27,640 --> 00:29:30,840 Speaker 1: was there? He got a CT scan, some pain meds, 607 00:29:30,880 --> 00:29:33,120 Speaker 1: and some stitches. That was it. That was it. So 608 00:29:33,160 --> 00:29:35,200 Speaker 1: it was very very basic. It was a pretty yeah. 609 00:29:35,240 --> 00:29:37,480 Speaker 1: I mean it was not a complicated visit. And you know, 610 00:29:37,560 --> 00:29:39,760 Speaker 1: this is a case where he had no choice. You know, 611 00:29:40,120 --> 00:29:42,400 Speaker 1: he was knocked unconscious. I think healthcare is the only 612 00:29:43,080 --> 00:29:45,480 Speaker 1: good you purchase when you're not conscious. You know, someone 613 00:29:45,520 --> 00:29:47,640 Speaker 1: else called an ambulance. The ambulance took him to place. 614 00:29:48,040 --> 00:29:50,080 Speaker 1: You know, he's having this work done when he's not awake, 615 00:29:50,240 --> 00:29:53,440 Speaker 1: And I think that is that is One of the reasons, 616 00:29:53,480 --> 00:29:56,960 Speaker 1: you know, I find these er situations especially frustrating is 617 00:29:57,000 --> 00:29:59,720 Speaker 1: because you know, you do do have people who aren't 618 00:29:59,760 --> 00:30:01,840 Speaker 1: able to shop. You can't decide if you want to 619 00:30:01,880 --> 00:30:04,240 Speaker 1: go to the emergency room if you're having a true emergency, 620 00:30:04,680 --> 00:30:07,120 Speaker 1: and that creates this monopoly like behavior where you see 621 00:30:07,160 --> 00:30:10,440 Speaker 1: this billing at absurd rates because patients just can't say no. 622 00:30:11,360 --> 00:30:14,120 Speaker 1: The presumption from when I was younger, what was explained 623 00:30:14,160 --> 00:30:16,440 Speaker 1: to me once that they've got to charge everybody these 624 00:30:16,480 --> 00:30:18,760 Speaker 1: big numbers to keep the place hot and ready for 625 00:30:18,800 --> 00:30:21,600 Speaker 1: the serious catastrophic injury when you walk in the door 626 00:30:21,720 --> 00:30:23,960 Speaker 1: and you've got poison ivy and they got to give 627 00:30:23,960 --> 00:30:25,120 Speaker 1: you a bill to help pay for the guy that 628 00:30:25,200 --> 00:30:27,400 Speaker 1: had the steering wheel go through his neck. Yeah, I mean, 629 00:30:27,440 --> 00:30:31,160 Speaker 1: I hear that a lot from emergency room. I am 630 00:30:31,320 --> 00:30:33,760 Speaker 1: very skeptical of that argument one because I see the 631 00:30:33,840 --> 00:30:37,200 Speaker 1: prices just very the price of being prepared seems to 632 00:30:37,320 --> 00:30:41,000 Speaker 1: vary wildly from one hospital to another, so that it 633 00:30:41,080 --> 00:30:44,960 Speaker 1: seems a little bit of a false justification. I do understand, 634 00:30:45,000 --> 00:30:46,800 Speaker 1: you know, they need to keep the lights running, they 635 00:30:46,880 --> 00:30:48,400 Speaker 1: need to keep it on, they need to be ready 636 00:30:48,440 --> 00:30:50,880 Speaker 1: for the gunshot. Wounds, but they also charged the guy 637 00:30:50,920 --> 00:30:52,920 Speaker 1: with the gunshot wound a lot more than the poison 638 00:30:53,000 --> 00:30:56,360 Speaker 1: poison ivy person. Like, they essentially have these things called 639 00:30:56,440 --> 00:30:59,320 Speaker 1: facility fees where if you're you know, the poison ivy person, 640 00:30:59,400 --> 00:31:01,560 Speaker 1: you get a level one facility fee, but if you're 641 00:31:01,560 --> 00:31:03,200 Speaker 1: a gunshot person, you're going to get level five and 642 00:31:03,240 --> 00:31:05,280 Speaker 1: that's going to be quite expensive. So it's not like 643 00:31:06,440 --> 00:31:10,760 Speaker 1: I do understand people have to It doesn't happen in Canada, right, Like, 644 00:31:10,880 --> 00:31:13,960 Speaker 1: if you have a health care system where you decide 645 00:31:14,040 --> 00:31:17,920 Speaker 1: that patients shouldn't be the ones bearing those costs, then 646 00:31:18,760 --> 00:31:20,560 Speaker 1: you can avoid it if you want to create a 647 00:31:20,600 --> 00:31:23,560 Speaker 1: policy situation that avoids it. Plus that more and more 648 00:31:23,680 --> 00:31:28,479 Speaker 1: uninsured people are using emergency rooms for regular medical care. 649 00:31:28,520 --> 00:31:30,560 Speaker 1: They go there with the flu. They should be seeing 650 00:31:30,600 --> 00:31:33,080 Speaker 1: a doctor and they shouldn't be cluttering up emergency room, 651 00:31:33,120 --> 00:31:34,360 Speaker 1: but they got nowhere else to go because don't have 652 00:31:34,360 --> 00:31:36,360 Speaker 1: any insurance. Well, and I mean, one of the things 653 00:31:36,400 --> 00:31:38,280 Speaker 1: I see a lot and all these bills I read, 654 00:31:38,320 --> 00:31:40,520 Speaker 1: are people end up at the e er on nights 655 00:31:40,560 --> 00:31:43,760 Speaker 1: and weekends because they know it's not an emergency, but 656 00:31:43,840 --> 00:31:45,920 Speaker 1: it's the only thing that's open and you know, it's 657 00:31:45,960 --> 00:31:48,000 Speaker 1: often like their young kid did something at a weird 658 00:31:48,080 --> 00:31:50,600 Speaker 1: hour in the night, the urgent care said we can't 659 00:31:50,760 --> 00:31:53,000 Speaker 1: we don't see pediatrics or the orient cares and open, 660 00:31:53,040 --> 00:31:55,640 Speaker 1: so they go to the emergency room. So it just 661 00:31:55,840 --> 00:31:58,520 Speaker 1: it's it's a hard system for patients. There's like it 662 00:31:58,600 --> 00:32:00,840 Speaker 1: really feels stacked against you in that sort of way. 663 00:32:01,440 --> 00:32:04,120 Speaker 1: I mentioned who's a hero of the Republican side, and 664 00:32:04,200 --> 00:32:07,040 Speaker 1: you didn't come up with a name. Is there one 665 00:32:07,120 --> 00:32:10,120 Speaker 1: you think of that's a villain? Gosh, that's a good one. Um. 666 00:32:11,200 --> 00:32:13,120 Speaker 1: I mean, one of the hard things here is that 667 00:32:13,280 --> 00:32:15,840 Speaker 1: Republicans just they don't put a lot of their energy 668 00:32:15,880 --> 00:32:17,760 Speaker 1: into healthcare policy. I would say, you know, when I 669 00:32:17,880 --> 00:32:22,880 Speaker 1: was covering the repeal debate in seventeen, it was very 670 00:32:22,960 --> 00:32:24,680 Speaker 1: clear that, you know, Republicans are almost like the dog 671 00:32:24,760 --> 00:32:26,960 Speaker 1: that caught the car they won on this campaign to 672 00:32:27,000 --> 00:32:29,280 Speaker 1: repeal Obamacare, and I was like, oh crap, we actually 673 00:32:29,720 --> 00:32:31,880 Speaker 1: have to come up with a replacement, and they were 674 00:32:31,960 --> 00:32:34,680 Speaker 1: not able to do it. And I think, you know, 675 00:32:34,720 --> 00:32:37,320 Speaker 1: it just speaks like a fundamental difference in the issues 676 00:32:37,360 --> 00:32:41,840 Speaker 1: that Democrats and Republicans are thinking about. Democrats are thinking about, um, 677 00:32:42,320 --> 00:32:45,160 Speaker 1: you know, how can we cover more people? How can 678 00:32:45,240 --> 00:32:47,920 Speaker 1: we you know, make health care access more equitable. Republicans 679 00:32:48,000 --> 00:32:49,800 Speaker 1: wanted to repeal the Affordable Care Act, but I was 680 00:32:49,840 --> 00:32:51,960 Speaker 1: kind of like I didn't know what came next and 681 00:32:52,040 --> 00:32:54,560 Speaker 1: then what and it wasn't clear. Like whenever I would 682 00:32:54,560 --> 00:32:57,440 Speaker 1: interview people in about like, well, what are the goals 683 00:32:57,640 --> 00:33:00,640 Speaker 1: of this health care effort you're working on that would 684 00:33:00,640 --> 00:33:02,240 Speaker 1: become Obamacare and they say, you know, we want to 685 00:33:02,280 --> 00:33:04,600 Speaker 1: increase access and reduce cost. Would be some version of 686 00:33:04,680 --> 00:33:07,720 Speaker 1: that answer. When I would interview Republican legislators about this, 687 00:33:08,000 --> 00:33:09,800 Speaker 1: it'd be like, well, we want to repeal Obamacare, and 688 00:33:09,800 --> 00:33:12,920 Speaker 1: they think because they did not have and then what 689 00:33:13,680 --> 00:33:15,920 Speaker 1: it all fell apart? Who's the person that you think 690 00:33:16,000 --> 00:33:19,800 Speaker 1: expresses the best possibility of where we go forward from here? 691 00:33:20,200 --> 00:33:23,120 Speaker 1: So I think Sanders does have a very strong vision 692 00:33:23,440 --> 00:33:25,120 Speaker 1: for where we go from here that he spent a 693 00:33:25,200 --> 00:33:29,720 Speaker 1: lot of time thinking about. Gillibrand, Kamala, Harris Booker, all 694 00:33:29,760 --> 00:33:31,680 Speaker 1: of them are signed on to the Sanders Medicare for 695 00:33:31,760 --> 00:33:34,880 Speaker 1: All Bill. I think he really is. It is his issue, 696 00:33:35,000 --> 00:33:36,320 Speaker 1: you know, he spent a lot of time. I went 697 00:33:36,400 --> 00:33:38,920 Speaker 1: with him on a reporting trip to Toronto about a 698 00:33:39,000 --> 00:33:41,959 Speaker 1: year ago, you know, looking at the Canadian healthcare system. 699 00:33:42,480 --> 00:33:45,479 Speaker 1: You know, I think he very much understands the goals 700 00:33:45,520 --> 00:33:47,560 Speaker 1: of what he is doing, why he wants to do it. 701 00:33:48,480 --> 00:33:51,160 Speaker 1: I don't know that his vision is the one that 702 00:33:51,520 --> 00:33:53,360 Speaker 1: we end up with, but I think it's by far 703 00:33:53,480 --> 00:33:57,440 Speaker 1: the clearest articulation I've seen of like here's the problem, 704 00:33:57,960 --> 00:33:59,320 Speaker 1: here's how I want to fix it. And I think 705 00:33:59,360 --> 00:34:03,120 Speaker 1: Sanders end himself with the Canadian system, So he really 706 00:34:03,160 --> 00:34:07,000 Speaker 1: abhors the idea of having insurance like Britons that lets 707 00:34:07,040 --> 00:34:09,000 Speaker 1: you skip to the front of the line, and this 708 00:34:09,080 --> 00:34:10,799 Speaker 1: is like a very core principle for him. I think 709 00:34:10,800 --> 00:34:12,719 Speaker 1: it's also going to be a reason why his bill 710 00:34:12,760 --> 00:34:15,560 Speaker 1: would struggle in Congress. Um. You know, if I saw 711 00:34:15,680 --> 00:34:18,640 Speaker 1: us moving to a national system, I'd expect there'd be 712 00:34:18,680 --> 00:34:21,279 Speaker 1: some kind of private health insurance option. But I think, 713 00:34:21,360 --> 00:34:24,480 Speaker 1: you know, it's I think he probably stands out as 714 00:34:24,520 --> 00:34:26,400 Speaker 1: like the best articulator in the person who kind of 715 00:34:26,520 --> 00:34:30,120 Speaker 1: best understands why he wants the system he wants, Like 716 00:34:30,200 --> 00:34:32,799 Speaker 1: he has like a philosophical underpinning that kind of leads 717 00:34:32,880 --> 00:34:35,480 Speaker 1: him to make certain policy decisions. And his vision of 718 00:34:35,600 --> 00:34:38,800 Speaker 1: national health care and where are you calling that Medicare 719 00:34:38,880 --> 00:34:41,960 Speaker 1: for all, Yes, Moose candidates in Vision calling this national 720 00:34:42,040 --> 00:34:46,320 Speaker 1: program medicare. Medicare is really popular. It pulls well. I 721 00:34:46,400 --> 00:34:49,000 Speaker 1: think when you do polls of single payer versus Medicare 722 00:34:49,000 --> 00:34:52,600 Speaker 1: for all, people like medicare. Actually in Canada it's also 723 00:34:52,640 --> 00:34:55,440 Speaker 1: called medicare. So, um, it's a popular one. I mean, 724 00:34:55,440 --> 00:34:58,160 Speaker 1: it's worth noting the program Democrats want to create is 725 00:34:58,320 --> 00:35:00,920 Speaker 1: very different than Medicare care and Medicare you have to 726 00:35:01,000 --> 00:35:04,160 Speaker 1: kick in something like of your healthcare costs. Most people 727 00:35:04,200 --> 00:35:06,520 Speaker 1: buy private insurance to fill in the gaps in medicare. 728 00:35:07,040 --> 00:35:10,480 Speaker 1: So the program that they're suggesting is not giving the 729 00:35:10,560 --> 00:35:12,719 Speaker 1: current version of Medicare to everybody. But since we all 730 00:35:12,760 --> 00:35:14,880 Speaker 1: know what Medicare is, Medicare is popular, that's kind of 731 00:35:14,920 --> 00:35:19,000 Speaker 1: become the terminology for a health insurance plan for everyone. Um. 732 00:35:19,680 --> 00:35:22,520 Speaker 1: Why do you think what's the number one problem right 733 00:35:22,640 --> 00:35:25,799 Speaker 1: now today? You think with the pharmacy business, I mean, 734 00:35:25,800 --> 00:35:29,279 Speaker 1: I think the prices are the obvious problem. Insulin. You know, 735 00:35:29,320 --> 00:35:31,520 Speaker 1: this is something that was discovered in the ninete twenties 736 00:35:31,960 --> 00:35:35,000 Speaker 1: hasn't really changed the prices of insulin are so, and 737 00:35:35,120 --> 00:35:37,400 Speaker 1: insulin is something diabetics need to stay alive. This is 738 00:35:37,440 --> 00:35:40,240 Speaker 1: another case where you know, you can't shop for insulin. 739 00:35:40,360 --> 00:35:43,120 Speaker 1: You can't decide it's too expensive. So, you know, I 740 00:35:43,200 --> 00:35:46,279 Speaker 1: interviewed one patient to you to say, if I don't 741 00:35:46,360 --> 00:35:48,520 Speaker 1: take my insulin for a few days, I'm going to die. 742 00:35:48,600 --> 00:35:51,000 Speaker 1: Like I'm not, Like this is essentially like taking the 743 00:35:51,040 --> 00:35:53,560 Speaker 1: price of water and tripling it. And they're going to 744 00:35:53,600 --> 00:35:58,680 Speaker 1: get there and telling me and telling me as a patient, like, well, 745 00:35:58,800 --> 00:36:00,480 Speaker 1: you come up with the money for it. You know, 746 00:36:00,640 --> 00:36:05,040 Speaker 1: she's someone who she stays at these jobs she hates 747 00:36:05,120 --> 00:36:07,880 Speaker 1: because she just cannot live her life without health insurance. 748 00:36:07,920 --> 00:36:11,279 Speaker 1: So she her whole career. You know, she told me 749 00:36:11,360 --> 00:36:13,520 Speaker 1: one thing, she went to law school because she felt 750 00:36:13,560 --> 00:36:15,600 Speaker 1: like law was a stable profession because she'd always have 751 00:36:15,640 --> 00:36:18,800 Speaker 1: health insurance. Like that's a crazy way to live. That 752 00:36:18,920 --> 00:36:21,600 Speaker 1: she is making every professional decision, every personal decision her 753 00:36:21,680 --> 00:36:25,400 Speaker 1: life around access to insulin. And so I think, you know, 754 00:36:25,520 --> 00:36:28,360 Speaker 1: when things with pharma, the prices are outrageous in the 755 00:36:28,440 --> 00:36:31,360 Speaker 1: United States, and this comes back to the fact that 756 00:36:31,360 --> 00:36:34,040 Speaker 1: the US is the only country that is not regulating 757 00:36:34,080 --> 00:36:36,360 Speaker 1: the prices. You know, when a pharma company wants to 758 00:36:36,440 --> 00:36:39,399 Speaker 1: go sell a drug in the UK, they sit down 759 00:36:39,520 --> 00:36:43,480 Speaker 1: with this agency called NICE, the National Institute for Clinical Excellence, 760 00:36:44,040 --> 00:36:47,839 Speaker 1: and NICE basically decides, like pharma says, here's how much 761 00:36:47,920 --> 00:36:50,319 Speaker 1: we want to charge. NICE looks at how effective your 762 00:36:50,360 --> 00:36:52,680 Speaker 1: drug is and says, here's how much we're willing to pay, 763 00:36:52,920 --> 00:36:54,920 Speaker 1: and you know, if they can come to an agreement, 764 00:36:54,960 --> 00:36:57,520 Speaker 1: it gets added into the national program. There are some 765 00:36:57,640 --> 00:37:00,279 Speaker 1: drugs where you know, England says no, They're been a 766 00:37:00,360 --> 00:37:03,960 Speaker 1: lot of controversies around certain really expensive cancer treatments that 767 00:37:04,440 --> 00:37:07,440 Speaker 1: the national system in the UK won't cover because they 768 00:37:07,520 --> 00:37:10,440 Speaker 1: just don't think they're worth the money. So there certainly 769 00:37:10,440 --> 00:37:12,000 Speaker 1: are some trade offs that after you made like there 770 00:37:12,040 --> 00:37:14,800 Speaker 1: are some very outraged cancer patients in the UK, you 771 00:37:14,920 --> 00:37:17,120 Speaker 1: say like I want the government to cover this, and 772 00:37:17,200 --> 00:37:19,080 Speaker 1: they're not going to cover it, whereas in the US 773 00:37:19,200 --> 00:37:21,000 Speaker 1: you probably could get coverage for it, but it's going 774 00:37:21,080 --> 00:37:24,520 Speaker 1: to be incredibly expensive. So that's a big trade off 775 00:37:24,640 --> 00:37:26,680 Speaker 1: between a system like ours in a system you know, 776 00:37:26,800 --> 00:37:29,399 Speaker 1: like the UK's. But I would say, at some point 777 00:37:29,440 --> 00:37:31,680 Speaker 1: the drugs and we're at that point they're getting so 778 00:37:31,880 --> 00:37:34,920 Speaker 1: expensive that it's like, yes, you have access to them, 779 00:37:35,000 --> 00:37:36,520 Speaker 1: but if you can't afford them, what does that even 780 00:37:37,160 --> 00:37:39,800 Speaker 1: option when when you when you use insulin as an example, 781 00:37:39,840 --> 00:37:42,000 Speaker 1: when I'm wondering, what is it about their lobbying onto 782 00:37:42,040 --> 00:37:43,879 Speaker 1: the extent that you can talk about that that makes 783 00:37:43,920 --> 00:37:46,640 Speaker 1: them so powerful so affect Yeah, so there's just money. 784 00:37:47,080 --> 00:37:48,520 Speaker 1: I think a lot of its money. I think there 785 00:37:48,560 --> 00:37:50,960 Speaker 1: are these ads that ran during Clinton Care, these um 786 00:37:51,080 --> 00:37:53,120 Speaker 1: Harry and Louise ads that are kind of like burned 787 00:37:53,160 --> 00:37:57,000 Speaker 1: into the memory of anyone who worked in a campaign dollars, Yes, 788 00:37:57,080 --> 00:37:59,719 Speaker 1: campaign dollars, and they really launched like an all out 789 00:37:59,800 --> 00:38:03,120 Speaker 1: of salt on Clinton Care. That really was one of 790 00:38:03,160 --> 00:38:05,400 Speaker 1: the reasons why that was not able to go forward. 791 00:38:05,880 --> 00:38:08,560 Speaker 1: I think eval one on an Obamacare so they didn't 792 00:38:08,640 --> 00:38:10,279 Speaker 1: And this is you know, a theory of government that 793 00:38:10,360 --> 00:38:13,120 Speaker 1: the Obama administration had. The abministration felt like they could 794 00:38:13,160 --> 00:38:15,640 Speaker 1: not survive a pharma on slot. So one of the 795 00:38:15,719 --> 00:38:17,560 Speaker 1: things they did, and they felt the same way about 796 00:38:17,560 --> 00:38:19,880 Speaker 1: the A m A the hospitals. They felt like, if 797 00:38:19,920 --> 00:38:23,120 Speaker 1: these guys line up against us, this won't survive. So 798 00:38:23,239 --> 00:38:25,520 Speaker 1: they got them all to endorse the bill. And that 799 00:38:25,600 --> 00:38:27,320 Speaker 1: was a big trade off because there's sort of you know, 800 00:38:27,800 --> 00:38:30,160 Speaker 1: pharma was not going to endorse the bill that regulated 801 00:38:30,239 --> 00:38:32,640 Speaker 1: drug prices. So they said, Okay, with Obamacare, we are 802 00:38:32,719 --> 00:38:34,799 Speaker 1: not going to regulate drug prices. We'll put a small 803 00:38:34,840 --> 00:38:38,080 Speaker 1: tax on the farm industry. Basically, they created taxes on 804 00:38:38,120 --> 00:38:40,400 Speaker 1: all these industries but didn't regulate their prices, and that 805 00:38:40,520 --> 00:38:43,440 Speaker 1: got them all to sign on. You know, I I 806 00:38:43,520 --> 00:38:46,359 Speaker 1: don't know if the current Democrats operate under that theory 807 00:38:46,400 --> 00:38:49,040 Speaker 1: of governance anymore. I was, you know, just meeting with 808 00:38:49,239 --> 00:38:52,719 Speaker 1: Promilla Jayapaul, who runs the House Progressive Caucus and rolled 809 00:38:52,760 --> 00:38:56,040 Speaker 1: out of Medicare for All bill recently, and she basically 810 00:38:56,080 --> 00:38:58,640 Speaker 1: feels like, you know what, like that, like we are 811 00:38:58,680 --> 00:39:00,799 Speaker 1: beyond that, we are not having farm and where's their bill? 812 00:39:01,160 --> 00:39:04,879 Speaker 1: Like we are doing a bill you know, in goal 813 00:39:04,960 --> 00:39:06,799 Speaker 1: is to piste off farm us, spend as much money 814 00:39:06,800 --> 00:39:08,960 Speaker 1: as you want, like we are ready for it. They 815 00:39:09,000 --> 00:39:11,160 Speaker 1: see a lot of bad outcomes of bringing industry on 816 00:39:11,239 --> 00:39:13,280 Speaker 1: board with your healthcare bill, and kind of a different 817 00:39:13,360 --> 00:39:15,919 Speaker 1: view than Obama did going into the Affordable Care Act. 818 00:39:16,920 --> 00:39:20,080 Speaker 1: Let's assume that everything stays as it is right now, 819 00:39:20,760 --> 00:39:24,160 Speaker 1: and we have at least in Congress, we have a 820 00:39:24,239 --> 00:39:28,680 Speaker 1: Republican Senate in a Democratic House, and the White House 821 00:39:29,000 --> 00:39:33,320 Speaker 1: changes hands. Sanders or whoever, Kamela Harris, whoever in the 822 00:39:33,360 --> 00:39:36,520 Speaker 1: White House. What kind of plan do you think there's 823 00:39:36,560 --> 00:39:38,400 Speaker 1: a chance we can end up with or I think 824 00:39:38,440 --> 00:39:39,840 Speaker 1: you see a lot of like the assault in the 825 00:39:39,880 --> 00:39:42,200 Speaker 1: Affordable Care Act, they probably redo some of the stuff 826 00:39:42,200 --> 00:39:44,239 Speaker 1: you can do through the executive branch. Try and shore 827 00:39:44,320 --> 00:39:47,080 Speaker 1: that up. It's going to be hard to do these 828 00:39:47,160 --> 00:39:50,040 Speaker 1: sort of things through executive action, you know, it is 829 00:39:50,080 --> 00:39:53,160 Speaker 1: going to be hard without having the Senate. It is 830 00:39:53,200 --> 00:39:56,400 Speaker 1: hard to do a half ast version a weird idea 831 00:39:56,440 --> 00:39:59,319 Speaker 1: I've heard floated, which like seems to engender a lot 832 00:39:59,360 --> 00:40:01,840 Speaker 1: of lawsuits. It is much easier to just lower the 833 00:40:01,880 --> 00:40:05,520 Speaker 1: eligibility age of Medicare from six to zero, which is 834 00:40:05,560 --> 00:40:08,120 Speaker 1: like very odd way to do this, Like a lot 835 00:40:08,160 --> 00:40:10,000 Speaker 1: of benefits would be missing that It's like not the 836 00:40:10,040 --> 00:40:12,239 Speaker 1: Sanders plan, But I guess that would be like a 837 00:40:12,320 --> 00:40:15,120 Speaker 1: version of this um that could be done without as 838 00:40:15,200 --> 00:40:17,920 Speaker 1: much legislating. But I think it's going to be hard 839 00:40:17,960 --> 00:40:21,160 Speaker 1: and divided government to move forward on this um. I 840 00:40:21,200 --> 00:40:23,439 Speaker 1: think it's it's a big idea that gets a little 841 00:40:23,480 --> 00:40:26,800 Speaker 1: bit stuck in the wheels of Congress. Are you someone 842 00:40:26,880 --> 00:40:28,759 Speaker 1: who you think it's essential that we have to have 843 00:40:28,800 --> 00:40:31,320 Speaker 1: a tax increase in order to afford that we do. 844 00:40:31,480 --> 00:40:33,880 Speaker 1: I mean, we need to get the money from somewhere. 845 00:40:33,960 --> 00:40:36,120 Speaker 1: And you know, if you've talked to Bertie Sanders about this, 846 00:40:36,200 --> 00:40:38,799 Speaker 1: he'll say, yes, there'd be a tax increase, but also 847 00:40:38,840 --> 00:40:41,560 Speaker 1: nobody would be paying their health insurance premiums anymore. So 848 00:40:41,719 --> 00:40:43,960 Speaker 1: you know, the things is getting changed out of your paycheck. 849 00:40:44,480 --> 00:40:46,480 Speaker 1: You're taking out of your paycheck, just get changed a 850 00:40:46,600 --> 00:40:50,240 Speaker 1: little bit. But I think that is where these programs 851 00:40:50,320 --> 00:40:53,560 Speaker 1: run into a lot of challenges. There's this guy at Harvard. 852 00:40:53,640 --> 00:40:55,320 Speaker 1: His name is Williams. Show, and he's kind of like 853 00:40:55,760 --> 00:40:57,640 Speaker 1: if you're a country who wants to build single payer, 854 00:40:57,719 --> 00:41:00,879 Speaker 1: he's like the health economist you call. And when I've 855 00:41:00,920 --> 00:41:03,239 Speaker 1: interviewed him, he's worked without a dozen countries and he 856 00:41:03,280 --> 00:41:05,480 Speaker 1: says about half of them fail. And the reason they 857 00:41:05,520 --> 00:41:07,600 Speaker 1: fail is always the step of how do you pay 858 00:41:07,680 --> 00:41:09,200 Speaker 1: for the thing? Like you can come up with a 859 00:41:09,280 --> 00:41:12,000 Speaker 1: really cool system, but the place where it always gets 860 00:41:12,040 --> 00:41:13,879 Speaker 1: hard is like figuring out, Okay, how do we pay 861 00:41:13,960 --> 00:41:17,200 Speaker 1: for that system. Do you think that healthcare is at 862 00:41:17,200 --> 00:41:20,879 Speaker 1: a crisis in this country right now? Yes, I think, 863 00:41:21,800 --> 00:41:24,160 Speaker 1: And what qualifies I think what qualifies it as a 864 00:41:24,239 --> 00:41:28,480 Speaker 1: crisis as you have people still going into really significant 865 00:41:28,600 --> 00:41:31,600 Speaker 1: crippling debt to afford healthcare that they can't say no to. 866 00:41:31,840 --> 00:41:33,759 Speaker 1: Like I look at the example of insulin, like that 867 00:41:33,880 --> 00:41:36,400 Speaker 1: seems like a crisis to me, that people that there 868 00:41:36,680 --> 00:41:40,560 Speaker 1: are reported stories of people dying because they cannot afford 869 00:41:40,600 --> 00:41:43,800 Speaker 1: their insulin, Like that feels like it's something fair to 870 00:41:43,840 --> 00:41:46,239 Speaker 1: call a crisis. Um, what's next for you? What are 871 00:41:46,239 --> 00:41:48,239 Speaker 1: you working on now? I just know I need to 872 00:41:48,239 --> 00:41:52,120 Speaker 1: stop reading emergency room bills? Which country has the worst 873 00:41:52,120 --> 00:41:54,200 Speaker 1: health care system as far as you're concerned, Oh god, 874 00:41:54,239 --> 00:41:56,600 Speaker 1: I mean, I think we developed countries. It's got to 875 00:41:56,640 --> 00:41:58,640 Speaker 1: be the US, right, Like we if you look at 876 00:41:58,640 --> 00:42:04,600 Speaker 1: any rankings were always incredible, just incredible. The United States 877 00:42:04,760 --> 00:42:09,320 Speaker 1: healthcare system or Hodgepodge of systems, ranks the worst in 878 00:42:09,440 --> 00:42:13,280 Speaker 1: the developed world. We spend the most for the worst outcomes. 879 00:42:13,920 --> 00:42:17,880 Speaker 1: The United Kingdom spends literally half the amount per person 880 00:42:18,320 --> 00:42:22,400 Speaker 1: as the United States and fares better on hospital safety, 881 00:42:22,800 --> 00:42:28,600 Speaker 1: on many disease outcomes, on infant mortality, preventative care, and more. 882 00:42:29,320 --> 00:42:33,160 Speaker 1: Brits even live two years longer than Americans. You can 883 00:42:33,280 --> 00:42:38,920 Speaker 1: find Sarah Cliffs reporting, including her fabulous frustrating emergency room 884 00:42:39,000 --> 00:42:43,920 Speaker 1: billing project at vox dot com. Her podcast, telling the 885 00:42:44,040 --> 00:42:49,200 Speaker 1: human stories behind healthcare policy is called The Impact. This 886 00:42:49,400 --> 00:42:51,960 Speaker 1: is Alec Baldwin and you're listening to hear is the 887 00:42:52,080 --> 00:43:09,000 Speaker 1: Thing four for