Speaker 1: I'm Alec Baldwin and you're listening to Here's the thing.
Speaker 1: Democratic presidential primary already gives me a headache. Huge new
Speaker 1: policy initiatives get announced almost weekly by every player on
Speaker 1: a crowded field. It's a cacophony. The Family Act gives
Speaker 1: you about sixty of your wages guaranteed. Families that are
Speaker 1: making a hundred thousand dollars or less, we'll get up
Speaker 1: to five hundred dollars a month, which because every child
Speaker 1: in America a savings account. But all the major candidates
Speaker 1: have spoken with one voice about one thing, universal healthcare.
Speaker 1: Most have even endorsed Bernie Sanders Medicare for All bill,
Speaker 1: similar to Canada's National insurance system. Sounds simple, at least
Speaker 1: in theory, but as our President said, it's an unbelievably
Speaker 1: complex subject. Nobody knew that health care could be so complicate. Indeed,
Speaker 1: I needed someone to break it all down for me,
Speaker 1: and the choice was obvious. Sarah Cliff of Vox is
Speaker 1: the clearest, liveliest, most knowledgeable health care reporter out there.
Speaker 1: Not only has she spent thousands of hours reading all
Speaker 1: the major universal coverage proposals, really all of them, but
Speaker 1: she studied foreign systems too, especially her native Canada, and
Speaker 1: finally Cliff started out as a politics reporter. She gets
Speaker 1: that even the best bill doesn't do sick, cash strapped
Speaker 1: Americans any good if it's not calculated to get through
Speaker 1: Congress and onto the President's desk. As a savvy observer
Speaker 1: of politics, at one point, Sarah Cliff held out hope
Speaker 1: that the current president, understanding his base, might be the
Speaker 1: unlikely vehicle for reform. I remember the very start of
Speaker 1: right when he's coming it off, as he gave this
Speaker 1: inner view where he said he has a healthcare plan
Speaker 1: and it's going to cover everybody, and like it's going
Speaker 1: to be cheap and great. I remember I was up
Speaker 1: on the Capitol and like all his healthcare reporters are like, oh,
Speaker 1: maybe there's a plan, Like maybe he has a Like
Speaker 1: there's never a plan. There just is not a plan. Now,
Speaker 1: this is a topic so broad and so essential in
Speaker 1: people's lives, and is uh, you know, always in the
Speaker 1: top three of people's concerns politically during election cycles. What
Speaker 1: are we going to do to revamp or to improve healthcare?
Speaker 1: And in that conversation, and I want to keep this
Speaker 1: on very Layman's terms for the time being, because because
Speaker 1: because I'm a bit slow in this area, because people
Speaker 1: will point to the Canadian model and say, just to
Speaker 1: the north of US, Canada has this system. What does
Speaker 1: the Canadian system look like to you? What do they
Speaker 1: do and what don't they do? The Canadian system, I
Speaker 1: see it as one of the most equal health care
Speaker 1: systems in the world. So what they do, which is unique,
Speaker 1: is they offer a government run healthcare plan to all
Speaker 1: their residents with no charge when you go to the doctor.
Speaker 1: And that is true for hospital visits, for doctor visits,
Speaker 1: for kind of the base level medical benefits. And what
Speaker 1: they do to kind of make that possible because it's
Speaker 1: kind of expensive, right to give everyone healthcare with no
Speaker 1: fees when you go to the doctor, they make it
Speaker 1: a pretty limited benefit package. So there is not vision care,
Speaker 1: there is not dental care. Prescription drugs actually aren't covered
Speaker 1: in the Canadian system, which is now seen by Canadians
Speaker 1: is a pretty big gap and something some Canadian politicians
Speaker 1: are trying to fix. But what they really believe is
Speaker 1: that for this core set of benefits, everyone rich, poor,
Speaker 1: they should all have access to it. Nobody should be
Speaker 1: paying when they go to the doctor, and they do
Speaker 1: end up with slightly longer wait times as a result.
Speaker 1: But most Canadians I've talked to about this, they're fine
Speaker 1: with us as long as the rich Canadians and the
Speaker 1: poor Canadians have to wait the same amount of time.
Speaker 1: Right now. Now, when they were arguing about whether or
Speaker 1: not to have this in because you can talk a
Speaker 1: little bit from the history of it, how did it
Speaker 1: come about, What was the argument that won the day,
Speaker 1: How did they actually pull it off there that they
Speaker 1: convinced that the government and the people of the country
Speaker 1: that it was in their interest to pay for the
Speaker 1: lion's share of their medical care. Yeah, so it's kind
Speaker 1: of a wild story from Saskatchewan history, which most people
Speaker 1: are not very versed. I'm dying it's the most exciting
Speaker 1: Saskatchewan history you'll probably learn all day. So what happened,
Speaker 1: and it really has some striking parallels to where we
Speaker 1: are in the US right now. In the nineteen sixties,
Speaker 1: there was a socialist running to be the premier, which
Speaker 1: essentially the Canadian version of governor of Saskatchewan. This guy
Speaker 1: named Tommy Douglas. Tommy Douglas was running on a healthcare platform.
Speaker 1: He was running on the idea that healthcare should be
Speaker 1: a human right Canada. You know, kind of at a
Speaker 1: healthcare system, a more rudimentary version of what we have
Speaker 1: right now. Women were providing care at home to the
Speaker 1: best of their ability. There was kind of a makeshift
Speaker 1: system of doctors. What Tommy Douglas really argued in his
Speaker 1: campaign and the campaign that he won, was that health
Speaker 1: care should be a right for all Saskatchewan residents. And
Speaker 1: there's a lot of parallels with the Bernie Sanders campaign.
Speaker 1: I think, you know, this is a socialist running to
Speaker 1: be the first socialist premier in Canada. He wins, and
Speaker 1: then he has to implement the thing. And in nineteen
Speaker 1: sixty two, July one, nineteen sixty two, Saskatchewan becomes the
Speaker 1: first universal health care system in North America provincially. So
Speaker 1: now we're just looking at one province Canada, eleven provinces.
Speaker 1: It is so similar to where we are now. Conservatives
Speaker 1: making the argument that they don't want the government involved
Speaker 1: in medicine, that they know best, that they're worried, you know,
Speaker 1: that the government is going to choose what health care
Speaker 1: you get, and one health care you don't and all
Speaker 1: the doctors go on strike and Saskatchewan has to fly
Speaker 1: in British doctors from the National Health Care Service to
Speaker 1: staff their emergency rooms. It's pretty it's like a wild story.
Speaker 1: And twenty three days so the doctor what end of
Speaker 1: the strike is. They also fly in this mediator between
Speaker 1: the Saskatchewan government and the Saskatchewan doctors and they get
Speaker 1: a few concessions and is known as the Saskatoon Agreement,
Speaker 1: settled on July twenty nine two. And what they agree
Speaker 1: to is that doctors are allowed to opt out of
Speaker 1: the system if they want that they don't have to
Speaker 1: participate in government health insurance. They can just work privately.
Speaker 1: But if they are going to work privately, they can't
Speaker 1: accept government insurance. So it makes a big trade off.
Speaker 1: The fees get raised a little bit, they get a
Speaker 1: bit of a pay raise, and the doctors agree to
Speaker 1: come back to work. And Tommy Douglas, the premier who
Speaker 1: started all this is actually a bit of an icon
Speaker 1: in Canada now. The CBC, the Canadian Broadcasting Corporation, in
Speaker 1: two thousand four hosted this kind of odd television event
Speaker 1: where they decided they would vote on like who was
Speaker 1: the greatest Canadian and he was the winner. He was
Speaker 1: voted in this like primetime special player. But right do
Speaker 1: you think Wayne? Exactly? Um, So what happens after Saskatchewan
Speaker 1: does national healthcare? You quickly see other provinces building their
Speaker 1: own healthcare systems, to the point now that within a
Speaker 1: decade or so, Canada had national healthcare. And they pay
Speaker 1: for all this with tax revenue. So Canada has significantly
Speaker 1: higher taxes than we do, and that money is federal
Speaker 1: income taxes is what they're financing the whole system with.
Speaker 1: When the agreement was made, when the mediator from the
Speaker 1: British healthcare system comes in and mediates the whole thing
Speaker 1: and they have what was that with the Saskatoon agree agreement?
Speaker 1: What do you what do you think was said to
Speaker 1: if you recall or what do you think finally convinced
Speaker 1: them to support this idea? I mean, I think there
Speaker 1: was decent political support. So you know, you do have
Speaker 1: the doctor saying we don't want to involved in healthcare,
Speaker 1: but you also have this premier who has run this
Speaker 1: campaign promising universal healthcare. It's popular, you know, just in
Speaker 1: the out played politically. I think they got outplayed. I
Speaker 1: think they realized once they got three weeks into this strike,
Speaker 1: you know, the government was not going to bend. They
Speaker 1: kept saying, we'll come back to work if you don't
Speaker 1: do this Medicare for All program, and the government just
Speaker 1: said no, you know, and eventually the doctors needed a job, right,
Speaker 1: like you can only go out of work for so long.
Speaker 1: They were like the air traffic controller exactly under. And
Speaker 1: you actually see similar things from when Medicare launched in
Speaker 1: nineteen sixty five in the US. You saw some hospitals
Speaker 1: in the South, because of some of the rules around
Speaker 1: race that you had to treat patients of all race
Speaker 1: if you were going to participate in the Medicare program.
Speaker 1: You saw some hospitals in the South say, you know, well,
Speaker 1: we're not going to take Medicare, and eventually they caved
Speaker 1: because the government has a pretty powerful tool, right, They're
Speaker 1: going to pay you a lot of money to cover
Speaker 1: healthcare bills. Usually we've seen historically healthcare providers come around
Speaker 1: and accept that money. Why do you think the same
Speaker 1: thing hasn't happened here. We've never actually seen a state
Speaker 1: try and do single payer in the United States. We've
Speaker 1: never seen a state get as far as Saskatchewan did,
Speaker 1: and I think part of that might be the lobbying
Speaker 1: that happens even before you get that far. So I think,
Speaker 1: you know, you haven't seen legislators be willing to go
Speaker 1: far enough. You know, you did see Medicare and acted,
Speaker 1: and that was a big step in nineteen sixty five
Speaker 1: when the government created Medicare for the elderly Medicaid for
Speaker 1: the poor, and that was something the a m A,
Speaker 1: the American Medical Association, and they opposed both of those programs,
Speaker 1: which now are quite popular in the United States. So
Speaker 1: the popularity is what silence is the medical community. I
Speaker 1: think the popularity certainly makes it hard to lobby against them.
Speaker 1: It's a lot I think would be very, very hard
Speaker 1: for the A m A to launch a campaign today
Speaker 1: is saying, you know, get rid of Medicare and go
Speaker 1: back to the way it was. When you have millions
Speaker 1: of Americans who are on Medicare, who like their Medicare plans,
Speaker 1: that's a pretty tough sell. How long after the creation
Speaker 1: of Medicare and Medicaid, both programs became the equivalent of
Speaker 1: like settled law. They're not under any threat. They're there
Speaker 1: to stay. I mean decades for Medicaid. I think medicaids
Speaker 1: a pretty interesting example. So Medicaid covers low income Americans
Speaker 1: and it's a state program, so your state has to
Speaker 1: opt into it. In six five it's created. How many
Speaker 1: states opt into it? Now all of them? But that
Speaker 1: was not the case. Only about a dozen or so
Speaker 1: states signed on at first because one of the things
Speaker 1: the government said is, you know, we're going to pay
Speaker 1: part of the medical bills, usually most of the medical bills,
Speaker 1: but you're going to have to kick in some money too.
Speaker 1: It wasn't until nine that all states participated in medicaid.
Speaker 1: So we're talking about twenty four years from the start
Speaker 1: of medicaid to universal medicaid in the US. We were
Speaker 1: joking before we started recording with you that you were
Speaker 1: given an assignment. You were like, oh God, not this,
Speaker 1: And now years later you're an expert in this field. Yes,
Speaker 1: it was a little bit of happenstance. My first job
Speaker 1: was at Newsweek magazine here in New York, and I
Speaker 1: was an intern there um in right around when President
Speaker 1: Obama was making his first run for office, and I
Speaker 1: was on the politics team. The election died down. There
Speaker 1: are too many people on politics and I got moved
Speaker 1: to healthcare and this healthcare debate was starting up in
Speaker 1: d C. So I kind of just raised my hand
Speaker 1: to cover it, you know, not knowing that what thirteen
Speaker 1: years later, I would still be writing about the same thing.
Speaker 1: But I think what I really love about this topic
Speaker 1: is that there's such an intersection between the policy decisions
Speaker 1: that are made and the personal stories. Like you said,
Speaker 1: this is such like a human topic. There's so much
Speaker 1: at stake when people can or can't afford healthcare. A
Speaker 1: lot of the work I do right now is around
Speaker 1: healthcare pricing. You know, how much is charged for healthcare.
Speaker 1: And we've made this decision as the United States not
Speaker 1: to regulate our healthcare prices, and it's a very unusual
Speaker 1: decision for a developed country to make. I talked to
Speaker 1: a family in California who have a daughter with a
Speaker 1: rare condition, and they were charged twenty dollars for an
Speaker 1: m r I. Like that is an astronomical because Stanford
Speaker 1: wanted to charge dollars for an m r I. Because
Speaker 1: you can make a lot of money charging twenty dollars
Speaker 1: for m r I. No one challenge them, nobody, no regulators, No, Well,
Speaker 1: there's no regulator to challenge them in the US, You're
Speaker 1: about to charge whatever they can get away with. Yeah,
Speaker 1: so you know in this like in this particular case,
Speaker 1: they needed to see a certain specialist who is there,
Speaker 1: and the specially said, oh, let's take an m R I.
Speaker 1: And they figured, you know, how much can an m
Speaker 1: R I cost? Maybe a few thousand dollars. They weren't
Speaker 1: warned by the person how much the m R I was,
Speaker 1: and honestly, the person probably didn't know. One of the
Speaker 1: things I hear a lot from doctors because I'm quite
Speaker 1: critical of pricing that well, we're just trying to provide
Speaker 1: the best care. We don't know the prices. And that
Speaker 1: might be the case, but you know, not knowing the
Speaker 1: prices has a huge effect on the patients. I think
Speaker 1: sometimes when I talk to doctors, I feel like some
Speaker 1: of their views are a little bit myopic, that their
Speaker 1: focus is on, you know, we just need to provide
Speaker 1: the best care and the patient's going to deal with
Speaker 1: the bill later. Like the bill could be catastrophic for
Speaker 1: this family. They're not poor, but this bill is a
Speaker 1: quarter of their income for the entire year. And you know,
Speaker 1: the hospital just kind of said well, that's that's our price,
Speaker 1: and now they're stuck with it. Um. So, you know,
Speaker 1: I really think it's such like an interesting, fascinating beat
Speaker 1: where you can see the policy decisions being made in
Speaker 1: d C, being made in state houses, of such personal
Speaker 1: effects on all of us. It's so universal, you know,
Speaker 1: no one gets stopped out of the healthcare system. Was it?
Speaker 1: There was some neo sporing his daughter. He has like
Speaker 1: a one year old, and she managed to tie a
Speaker 1: piece of her hair around her toe really tightly, to
Speaker 1: the point it was turning blue. He takes her to
Speaker 1: the e R because it's the weekend. Everything else it's closed.
Speaker 1: Turns out it's totally fine. They put the news boring
Speaker 1: on it, head home. A few weeks later they get
Speaker 1: a bill for six for this interaction. You know, I
Speaker 1: think price transparency would be a start. You know. I
Speaker 1: think who's opposed to that the hospitals, you know, because
Speaker 1: it's it's a great system right for hospitals right now
Speaker 1: where you can like take people who need care and
Speaker 1: then build them whatever and the alley on the way home,
Speaker 1: like that's a that's a system that really advantages hospitals.
Speaker 1: The American Hospital Association. So what does the medical profession
Speaker 1: itself say on the record of what kind of healthcare
Speaker 1: they think the country should have. So I think they
Speaker 1: generally I see them as aligning with the Hospital Association.
Speaker 1: They are the people who are providing care pretty similar
Speaker 1: to hospitals, so they want to be you know, they
Speaker 1: generally support widespread access to care. They were supporters of
Speaker 1: the Affordable Care Act and the expansion of coverage. They
Speaker 1: also support, you know, pretty high they want to get,
Speaker 1: you know, and this is where you get into you
Speaker 1: you can frame it different ways. They want to get
Speaker 1: what they say are reasonable rates for the services they provide.
Speaker 1: If you're opposing them, if you're an insurance company, you're
Speaker 1: going to say they want to get outrageous rates for
Speaker 1: the care that they provide. But they generally support access
Speaker 1: to care as long as they're getting paid the amount
Speaker 1: they would like to get paid. And you know, I
Speaker 1: will say it's hard to paint doctors with a broad
Speaker 1: brush where you have an interesting split. There's been some
Speaker 1: interesting research if you look at the political affiliations of doctors,
Speaker 1: where you see primary care doctors, obstetricians generally lower paid
Speaker 1: fields in medicine. They tend to lean more liberal, align
Speaker 1: with the Democratic Party. Higher paid doctors and stusiologists. Radiologists
Speaker 1: tend to be a lot more conservative. So I will say,
Speaker 1: you know, there are doctors who support single payer. There
Speaker 1: are doctor who oppose the Affordable Care Act, but generally
Speaker 1: if you look at their lobby, they're okay with expanding
Speaker 1: coverage as long as they're getting paid a decent amounts. Now,
Speaker 1: in Canada, where there's this core of services that are
Speaker 1: basic services that are covered by the government, you pay nothing.
Speaker 1: Does the majority of the population then go out and
Speaker 1: get a supplemental policy to cover the other side dental
Speaker 1: and vision and so forth. They do about two thirds
Speaker 1: of Canadian care some kind of supplemental policy. Also for
Speaker 1: drugs too, is a major thing that people are buying
Speaker 1: their policies for that often works actually pretty similar to
Speaker 1: American insurance, where it's a benefit at work is that
Speaker 1: your employer will offer a supplemental plan. One of the
Speaker 1: things that's actually pretty unique about the Canadian healthcare system
Speaker 1: is they won't let you buy duplicat of coverage. So
Speaker 1: if you live in Britain, you also get your basic plan.
Speaker 1: But let's say you want a private hospital room, or
Speaker 1: you want to jump to the front of the line
Speaker 1: for hip surgery, you can buy a private plan that
Speaker 1: will give you those benefits. In Canada, they and it's
Speaker 1: been the subject of Canadian court cases, they will not
Speaker 1: allow that kind of duplicat of coverage because they think
Speaker 1: it cuts against the equality of their system. So they
Speaker 1: want to force you to standard line with everybody else,
Speaker 1: even if you don't, even if you have the means.
Speaker 1: So you have that description of the system in Canada.
Speaker 1: We're gonna get to the US in a moment, talk
Speaker 1: about the systems in in the UK. In the UK,
Speaker 1: so they you know, in some ways it's a much
Speaker 1: more public system. The hospitals, the doctors, many of them
Speaker 1: are working for and owned by the government. So whereas
Speaker 1: in Canada you have a public health plan with private
Speaker 1: doctors and hospitals, in the UK you have a public
Speaker 1: health plan and public doctors in hospital the government. Everyone's
Speaker 1: on the payroll of the government. Pretty favorably. You know,
Speaker 1: Brits are pretty proud of their system. If you look
Speaker 1: at international rankings. The Commonwealth Fund, which is a really
Speaker 1: respected healthcare nonprofit, they rank the British one above the
Speaker 1: Canadian one. But you know, I think what's interesting is
Speaker 1: even though Britain is such a public system, you also
Speaker 1: about ten percent of Brits who are buying this duplicate
Speaker 1: of coverage to you know, get to the frontal line,
Speaker 1: get their private room that they do allow insurance to
Speaker 1: compete with their plan. And they think of it as
Speaker 1: like a safety valve, like letting people out of the
Speaker 1: system into the private system. That frees up some of
Speaker 1: the public doctors for lower income people, and it lets
Speaker 1: the people who want to buy their way duplicative are
Speaker 1: you know, I don't know if I would say a supporter,
Speaker 1: I think it's a more realistic system for the US.
Speaker 1: I think, you know, we have a system where high
Speaker 1: income people are very used to being able to buy
Speaker 1: the care that they want to buy, and why shouldn't
Speaker 1: they you know, in Canada, they would argue, because your
Speaker 1: access to health care shouldn't depend on if you're rich
Speaker 1: and poor, and you know, if there's a baseline of
Speaker 1: healthcare that's paid for with the public dollar for them,
Speaker 1: why would you condemn other people who could have better
Speaker 1: healthcare because you'd worry about that private system of writing
Speaker 1: the public system. So Let's say you know, in the
Speaker 1: private system, doctors are earning more, they like it better,
Speaker 1: they just stop seeing public patients and they create a
Speaker 1: practice where the well, you didn't allow that, you said
Speaker 1: you have to do both. So I think it gets
Speaker 1: to like some core philosophical differences between like the UK
Speaker 1: and Canada, Whereas Canada, you know, at the core of
Speaker 1: their system, they just don't think money should buy you
Speaker 1: better health and where everyone to be in pain at
Speaker 1: the same time, want everyone poor and rich to be
Speaker 1: in pain and get better at the exact same time. Like,
Speaker 1: there's this great quote and um tr read he's a
Speaker 1: fantastic journalist. He wrote this book, like he um. I
Speaker 1: think he's a freelance journalist now, but he used to
Speaker 1: write for the Washington Post. And he wrote a book
Speaker 1: in twenty comparing um It's called Getting Better, Comparing Different
Speaker 1: Healthcare Systems. And he's a fantastic quote in it that
Speaker 1: I've always loved. I feel like it summarizes the Canadian
Speaker 1: healthcare system better than anything else. Someone told him Canadians
Speaker 1: don't mind waiting in line for healthcare as long as
Speaker 1: they know the rich Canadians and the poor Canadians are
Speaker 1: waiting the exact same amount of time. I think Australia
Speaker 1: has a fascinating healthcare system, so they, unlike Canada, they
Speaker 1: really encourage people to buy a private plan. So I
Speaker 1: actually think, like the more I've learned about Australia system,
Speaker 1: that they're a promising model for the US where because
Speaker 1: they don't they they've run into challenges raising enough tax revenue.
Speaker 1: They've decided to deal with that not by shrinking the
Speaker 1: benefits or weights, but basically encouraging people to buy a
Speaker 1: private plan that is competing against their own plan, which
Speaker 1: feels like a much more American version of a healthcare system.
Speaker 1: So this issue in this country obviously appears to be
Speaker 1: a very partisan issue. Are there any Republicans that you
Speaker 1: can name off the top of your head where you
Speaker 1: think are strong on good reforms in healthcare. I think
Speaker 1: a lot of Republican voters are interested in Medicare for all.
Speaker 1: That's one of the things that surprised me. I was
Speaker 1: actually doing some reporting and this area of Kentucky that
Speaker 1: went for Trump, but also it's a ton of Obamacare enrollment,
Speaker 1: you know, as reporting on why did all these Obamacare
Speaker 1: rallies vote for Trump? And I wasn't there to talk
Speaker 1: about Medicare for all, but one of the things that
Speaker 1: came up multiple times from Republican voters was I wish
Speaker 1: we could have a system like Canada's, you know. And
Speaker 1: these are people who you know, supported President Trump, knew
Speaker 1: he wanted to repeal the Affordable Care Act, telling me
Speaker 1: they like Canada's healthcare system. And I think this is
Speaker 1: a place where you see a bit of a divide
Speaker 1: between legislators and like the Republican base and how they
Speaker 1: think about healthcare. That was healthcare guru Sarah cliff a Vox.
Speaker 1: If you want to hear Bernie Sanders ideas straight from
Speaker 1: the horse's mouth. Here's the thing, as you covered, what
Speaker 1: is the function of an insurance company. It's not to
Speaker 1: provide quality care to of course the effect, the ways
Speaker 1: to make as much money as they possibly can. And um,
Speaker 1: you know what I think makes sense to me is
Speaker 1: we have right now a fairly popular successful program, cold Care.
Speaker 1: It works pretty well for people sixty years of age old.
Speaker 1: Why not expand it to everybody? Here's the thing. Dot
Speaker 1: org is where you can find my whole interview with
Speaker 1: Bernie Sanders, now a declared candidate for the Democratic nomination
Speaker 1: to the presidency. In this is Alec Baldwin and you're
Speaker 1: listening to here's the thing. Sarah Cliff cut her Healthcare
Speaker 1: reporting Teeth covering the two thousand nine debate over Obamacare
Speaker 1: for Newsweek. I wanted to understand what Republican objections to
Speaker 1: the policy had been back then. That is going to be,
Speaker 1: you know, government takeover of healthcare, that the government was
Speaker 1: going to dictate which doctors you saw. I only talk
Speaker 1: government takeover of health care to the idea that big
Speaker 1: government is always bad and always leads to something ineffective.
Speaker 1: And did they were there anybody who are taking any
Speaker 1: specific reasons why they thought it was better? I think.
Speaker 1: I think the more thoughtful critique that I saw from
Speaker 1: Republican legislators is that one of the things Obamacare was
Speaker 1: going to do. It was going to require health insurance
Speaker 1: plans to cover a wide array of benefits, so something
Speaker 1: like maternity care, for example. Usually in the individual market
Speaker 1: before Obamacare, health insurance just would not cover pregnancy because
Speaker 1: pregnancy is expensive, so that would just be a benefit
Speaker 1: that would not be included in your package. One of
Speaker 1: the things Obamacare would do, and this is along with
Speaker 1: like prescription drugs and mental health services. It told insurance companies,
Speaker 1: you have to cover this wide suite of benefits. I
Speaker 1: heard conservatives making the argument, you know, people should be
Speaker 1: free to choose. They should be free to choose a cheaper,
Speaker 1: skimpier health insurance plan and have that cheaper coverage, and
Speaker 1: not everyone should be forced into these larger plans. So
Speaker 1: it's a bit of like a philosophical difference I think
Speaker 1: about healthcare right, like, whether we think, because we're all
Speaker 1: members of society and we all participate in healthcare, we
Speaker 1: should be required to purchase coverage for this wide suite
Speaker 1: of benefits, or if we should give people the option
Speaker 1: to buy these skimpier plans that often, you know, leave
Speaker 1: people a little flat footed when they actually do need
Speaker 1: to go to the doctor. I think that was a
Speaker 1: key actual divide and how the two parties thought about policy.
Speaker 1: So do you think that there's some sense to that,
Speaker 1: which is that we should give people some choice. It's
Speaker 1: it's hard, right because if you leave out maternity care,
Speaker 1: you know, that puts the entire cost on anyone who's
Speaker 1: going to have a baby. The whole point of health
Speaker 1: insurance is to spread our healthcare costs out among a
Speaker 1: wide group of people, so that it's roughly affordable for
Speaker 1: all of us. You know, even when you know, I
Speaker 1: had a baby last year, that's being spread out among
Speaker 1: my health insurance plans, and the years I don't have
Speaker 1: a baby, I'm kind of contributing to the other people
Speaker 1: having kids. It's really hard to let someone opt out
Speaker 1: and have a health insurance system still work, you know.
Speaker 1: That being said, you know, one thing the Affordable Care
Speaker 1: Act did is it did let younger people purchase catastrophic coverage,
Speaker 1: you know, coverage that paid for a smaller boundaryr benefits
Speaker 1: essentially like if you get hit by a bus, it
Speaker 1: kicks in, but you know, and that went up to
Speaker 1: age thirty under the Affordable Care Act. Republicans would have
Speaker 1: liked to let everyone by catastrophic coverage, but it's a
Speaker 1: big trade off. You really disadvantage when you let healthy
Speaker 1: people just you know, buy these skimpy plans. You're really
Speaker 1: going to disadvantage the sicker people who need well. It
Speaker 1: becomes power, like you either in it or you're out
Speaker 1: right yeah, I mean, Democrats didn't like the individual mandate
Speaker 1: was an incredibly unpopular policy, but The whole reason they
Speaker 1: included it is because if you are going to make
Speaker 1: an insurance system work, you need a lot of people
Speaker 1: buying in. You need the sick people, you need the
Speaker 1: healthy people. And when you have an array of options,
Speaker 1: when you have like the skimpy plan and the robust plan,
Speaker 1: the healthy people by the skimpy plans, they don't use
Speaker 1: much healthcare, the you know, sick people by the expensive
Speaker 1: plan with lots of benefits, and the insurance market, you know,
Speaker 1: essentially breaks down a little. You need the healthy people
Speaker 1: subsidizing the sick people in order to make things work.
Speaker 1: But where, and just philosophically, when we'll government and society say,
Speaker 1: hey man, your forty pounds were more overweight, and you're
Speaker 1: over fifty, and your cardiac cat scans at the following metrics.
Speaker 1: To us, your your insurance gonna go way up. Maybe
Speaker 1: you can smoke right right now, they're saying, when you
Speaker 1: get a discount, if you don't smoke, you get a
Speaker 1: preferred rate. If you don't smoke. When are we gonna
Speaker 1: start to hand people the bill for their bad behavior?
Speaker 1: Do you ever see any countries to do that? Well?
Speaker 1: In the Affordable Care Act actually under Obamacare. If you're
Speaker 1: buying an Obamacare plan, there is a question about whether
Speaker 1: you smoke, and if you do, you're going to be
Speaker 1: charged higher premiums. Um I don't know. I mean it's
Speaker 1: like a checkbox you could check no and get the
Speaker 1: cheaper premiums. I don't think anyone's really following up on that.
Speaker 1: I mean one of the things you actually see a
Speaker 1: lot doctors be obligated to report the fact that you
Speaker 1: do that. They're your doctors and they know what you're
Speaker 1: I don't know many people who smoke and line to
Speaker 1: their doctor about that. Sure, yeah, I mean it gets
Speaker 1: into some kind of tricky patient privacy issues or you
Speaker 1: don't want your doctor. But you know, you see a
Speaker 1: lot of corporate wellness programs and it's like kind of
Speaker 1: these ideas if you participate in the wellness program and
Speaker 1: like you meet certain wellness metrics, your company is going
Speaker 1: to give you a discount on your health insurance, like
Speaker 1: if you go to the gym or you know, sign
Speaker 1: up for some kind of program. And I mean it's
Speaker 1: like a tricky ray area. I don't know. I don't
Speaker 1: know about how national healthcare systems are handling that right now,
Speaker 1: but I think it's an issue that becomes a bigger one,
Speaker 1: you know, as you see obesity rates going up, not
Speaker 1: just here in the US but abroad, like that's a
Speaker 1: difficult one to handle. But it seems to me now
Speaker 1: that the inequity of healthcare and the way it plays
Speaker 1: out now has broadened in the last twenty five years,
Speaker 1: is it safe to say that that an increasing number
Speaker 1: of people don't have adequate healthcare now? So you did
Speaker 1: definitely see through the start of the Affordable Care Actor,
Speaker 1: a rising number of people without health insurance. And I
Speaker 1: think that largely has to do with the fact just
Speaker 1: healthcare got really expensive that There's actually some great charts,
Speaker 1: I know, they're great for audio, where they show like
Speaker 1: our healthcare costs used to be in line with the
Speaker 1: rest of the world through like the nineties or so,
Speaker 1: and then in the nineties and these charts you just
Speaker 1: see the US skyrocketing up, whereas like Canada, Netherlands, UK
Speaker 1: are like growing at a reasonable rate of like three
Speaker 1: or four percent a year, we start growing at seven
Speaker 1: or eight percent a year. And as healthcare costs rise,
Speaker 1: it's just harder for lower incompete boll to afford healthcare
Speaker 1: so you see this growing gap between rich and poor.
Speaker 1: You know, you don't see it for people over sixty
Speaker 1: five because they're on the Medicaid program. So everyone has
Speaker 1: access to healthcare once they get to sixty five. But
Speaker 1: Medicaid has always been like a pretty restrictive program. It's
Speaker 1: difficult to get on. It's limited to certain groups of people.
Speaker 1: You have how many people just Medicaid service now? So
Speaker 1: right now Medicaid actually services about sixty million Americans. It's
Speaker 1: a really big chunk of the population. And it's actually
Speaker 1: you know, the people who have gained health coverage under Obamacare,
Speaker 1: most of them have gotten it through Medicaid. Before Obamacare.
Speaker 1: To get on Medicaid, you had to be poor and something,
Speaker 1: so like poor and a mom, or poor and disabled.
Speaker 1: The Affordable Care Act said, you know, if you are
Speaker 1: an individual, you earn less than fifteen thousand dollars a year,
Speaker 1: there's no end. You just get Medicaid, um and that's
Speaker 1: the law. Now that is the law, well, it's sort
Speaker 1: of the law now. So the idea was this program
Speaker 1: would exist in all fifty states, but we had a
Speaker 1: Supreme Court decision in twenty eleven that said states get
Speaker 1: to choose whether and not they want to participate in
Speaker 1: Medicaid expansion. About two thirds of the states are participating,
Speaker 1: but some really big states Texas Florida have big populations
Speaker 1: of low income people who don't want to pay, and
Speaker 1: they only have to pay ten percent. I would say,
Speaker 1: you know, this is a really generous offer where they
Speaker 1: don't have income taxes in those state or other mechanisms
Speaker 1: to pay for and they want to keep it that way.
Speaker 1: There is no income tax in Texas and Florida's if
Speaker 1: iinder stand correctly, I think that's right. And you know
Speaker 1: they don't want to raise in any case, they don't
Speaker 1: want to raise the revenue to pay for those programs.
Speaker 1: Um so. And that's really so. You see what the
Speaker 1: Affordable Care Act coming into place in the uninsured rate drops,
Speaker 1: more people are gaining coverage. Can you see these trends
Speaker 1: of rising uninsured numbers reverse ever since Trump took office though,
Speaker 1: you've seen a bit of a reversal where some even
Speaker 1: though the Affordable Character is still standing law, some of
Speaker 1: the decisions they've made seem to have, you know, led
Speaker 1: to more people losing health insurance. So what are what
Speaker 1: are the most evil things you've seen hospitals and insurance
Speaker 1: companies do when you've been reporting on healthcare. Yeah, so
Speaker 1: I'm gonna give you two from the emergency room space
Speaker 1: because this year I've been doing this project on emergency
Speaker 1: rooms where people have been sending me their e er bill.
Speaker 1: So I read all sorts of horrific stories all day. Yes,
Speaker 1: I've read about six d emergency or bills in the
Speaker 1: last year. UM, And so two of the things that
Speaker 1: jumped out of me. You you just click through the
Speaker 1: you feel a little better about yourself when you're only
Speaker 1: dealing with a hundred fifty bucks. So one is Zuckerberg
Speaker 1: San Francisco General Hospital. So this is named for one
Speaker 1: Facebook founder who donated a lot of money to the
Speaker 1: public hospital. Um, they have made this really rare decision
Speaker 1: to be out of network with all private health insurance.
Speaker 1: They are also the only trauma center in San Francisco.
Speaker 1: So if you have a trauma, if you fall from
Speaker 1: a high height, if you are hit by a bus,
Speaker 1: an ambulance is going to take you to San Francisco
Speaker 1: General Hospital. And if you have private insurance, they are
Speaker 1: not going to be in network with your health insurance.
Speaker 1: So let me tell you like what patient I wrote
Speaker 1: about there? Who know, this is just like a horrific story.
Speaker 1: This is a guy named Justin who was walking on
Speaker 1: the sidewalk and this pole hanging off the back of
Speaker 1: a public bus hits him in the face and knocks
Speaker 1: him unconscious. Next thing he knows, he wakes up at
Speaker 1: San Francisco General. He has you know, severe concussion. He
Speaker 1: has a laceration to the face. He also ends up
Speaker 1: with a dollar bill. So this guy was hit by
Speaker 1: a public bus, taken to the public hospital, the public
Speaker 1: health bus. Yeah, like everything about this was so horrendous.
Speaker 1: Grand What kind of treatment did he receive when he
Speaker 1: was there? He got a CT scan, some pain meds,
Speaker 1: and some stitches. That was it. That was it. So
Speaker 1: it was very very basic. It was a pretty yeah.
Speaker 1: I mean it was not a complicated visit. And you know,
Speaker 1: this is a case where he had no choice. You know,
Speaker 1: he was knocked unconscious. I think healthcare is the only
Speaker 1: good you purchase when you're not conscious. You know, someone
Speaker 1: else called an ambulance. The ambulance took him to place.
Speaker 1: You know, he's having this work done when he's not awake,
Speaker 1: And I think that is that is One of the reasons,
Speaker 1: you know, I find these er situations especially frustrating is
Speaker 1: because you know, you do do have people who aren't
Speaker 1: able to shop. You can't decide if you want to
Speaker 1: go to the emergency room if you're having a true emergency,
Speaker 1: and that creates this monopoly like behavior where you see
Speaker 1: this billing at absurd rates because patients just can't say no.
Speaker 1: The presumption from when I was younger, what was explained
Speaker 1: to me once that they've got to charge everybody these
Speaker 1: big numbers to keep the place hot and ready for
Speaker 1: the serious catastrophic injury when you walk in the door
Speaker 1: and you've got poison ivy and they got to give
Speaker 1: you a bill to help pay for the guy that
Speaker 1: had the steering wheel go through his neck. Yeah, I mean,
Speaker 1: I hear that a lot from emergency room. I am
Speaker 1: very skeptical of that argument one because I see the
Speaker 1: prices just very the price of being prepared seems to
Speaker 1: vary wildly from one hospital to another, so that it
Speaker 1: seems a little bit of a false justification. I do understand,
Speaker 1: you know, they need to keep the lights running, they
Speaker 1: need to keep it on, they need to be ready
Speaker 1: for the gunshot. Wounds, but they also charged the guy
Speaker 1: with the gunshot wound a lot more than the poison
Speaker 1: poison ivy person. Like, they essentially have these things called
Speaker 1: facility fees where if you're you know, the poison ivy person,
Speaker 1: you get a level one facility fee, but if you're
Speaker 1: a gunshot person, you're going to get level five and
Speaker 1: that's going to be quite expensive. So it's not like
Speaker 1: I do understand people have to It doesn't happen in Canada, right, Like,
Speaker 1: if you have a health care system where you decide
Speaker 1: that patients shouldn't be the ones bearing those costs, then
Speaker 1: you can avoid it if you want to create a
Speaker 1: policy situation that avoids it. Plus that more and more
Speaker 1: uninsured people are using emergency rooms for regular medical care.
Speaker 1: They go there with the flu. They should be seeing
Speaker 1: a doctor and they shouldn't be cluttering up emergency room,
Speaker 1: but they got nowhere else to go because don't have
Speaker 1: any insurance. Well, and I mean, one of the things
Speaker 1: I see a lot and all these bills I read,
Speaker 1: are people end up at the e er on nights
Speaker 1: and weekends because they know it's not an emergency, but
Speaker 1: it's the only thing that's open and you know, it's
Speaker 1: often like their young kid did something at a weird
Speaker 1: hour in the night, the urgent care said we can't
Speaker 1: we don't see pediatrics or the orient cares and open,
Speaker 1: so they go to the emergency room. So it just
Speaker 1: it's it's a hard system for patients. There's like it
Speaker 1: really feels stacked against you in that sort of way.
Speaker 1: I mentioned who's a hero of the Republican side, and
Speaker 1: you didn't come up with a name. Is there one
Speaker 1: you think of that's a villain? Gosh, that's a good one. Um.
Speaker 1: I mean, one of the hard things here is that
Speaker 1: Republicans just they don't put a lot of their energy
Speaker 1: into healthcare policy. I would say, you know, when I
Speaker 1: was covering the repeal debate in seventeen, it was very
Speaker 1: clear that, you know, Republicans are almost like the dog
Speaker 1: that caught the car they won on this campaign to
Speaker 1: repeal Obamacare, and I was like, oh crap, we actually
Speaker 1: have to come up with a replacement, and they were
Speaker 1: not able to do it. And I think, you know,
Speaker 1: it just speaks like a fundamental difference in the issues
Speaker 1: that Democrats and Republicans are thinking about. Democrats are thinking about, um,
Speaker 1: you know, how can we cover more people? How can
Speaker 1: we you know, make health care access more equitable. Republicans
Speaker 1: wanted to repeal the Affordable Care Act, but I was
Speaker 1: kind of like I didn't know what came next and
Speaker 1: then what and it wasn't clear. Like whenever I would
Speaker 1: interview people in about like, well, what are the goals
Speaker 1: of this health care effort you're working on that would
Speaker 1: become Obamacare and they say, you know, we want to
Speaker 1: increase access and reduce cost. Would be some version of
Speaker 1: that answer. When I would interview Republican legislators about this,
Speaker 1: it'd be like, well, we want to repeal Obamacare, and
Speaker 1: they think because they did not have and then what
Speaker 1: it all fell apart? Who's the person that you think
Speaker 1: expresses the best possibility of where we go forward from here?
Speaker 1: So I think Sanders does have a very strong vision
Speaker 1: for where we go from here that he spent a
Speaker 1: lot of time thinking about. Gillibrand, Kamala, Harris Booker, all
Speaker 1: of them are signed on to the Sanders Medicare for
Speaker 1: All Bill. I think he really is. It is his issue,
Speaker 1: you know, he spent a lot of time. I went
Speaker 1: with him on a reporting trip to Toronto about a
Speaker 1: year ago, you know, looking at the Canadian healthcare system.
Speaker 1: You know, I think he very much understands the goals
Speaker 1: of what he is doing, why he wants to do it.
Speaker 1: I don't know that his vision is the one that
Speaker 1: we end up with, but I think it's by far
Speaker 1: the clearest articulation I've seen of like here's the problem,
Speaker 1: here's how I want to fix it. And I think
Speaker 1: Sanders end himself with the Canadian system, So he really
Speaker 1: abhors the idea of having insurance like Britons that lets
Speaker 1: you skip to the front of the line, and this
Speaker 1: is like a very core principle for him. I think
Speaker 1: it's also going to be a reason why his bill
Speaker 1: would struggle in Congress. Um. You know, if I saw
Speaker 1: us moving to a national system, I'd expect there'd be
Speaker 1: some kind of private health insurance option. But I think,
Speaker 1: you know, it's I think he probably stands out as
Speaker 1: like the best articulator in the person who kind of
Speaker 1: best understands why he wants the system he wants, Like
Speaker 1: he has like a philosophical underpinning that kind of leads
Speaker 1: him to make certain policy decisions. And his vision of
Speaker 1: national health care and where are you calling that Medicare
Speaker 1: for all, Yes, Moose candidates in Vision calling this national
Speaker 1: program medicare. Medicare is really popular. It pulls well. I
Speaker 1: think when you do polls of single payer versus Medicare
Speaker 1: for all, people like medicare. Actually in Canada it's also
Speaker 1: called medicare. So, um, it's a popular one. I mean,
Speaker 1: it's worth noting the program Democrats want to create is
Speaker 1: very different than Medicare care and Medicare you have to
Speaker 1: kick in something like of your healthcare costs. Most people
Speaker 1: buy private insurance to fill in the gaps in medicare.
Speaker 1: So the program that they're suggesting is not giving the
Speaker 1: current version of Medicare to everybody. But since we all
Speaker 1: know what Medicare is, Medicare is popular, that's kind of
Speaker 1: become the terminology for a health insurance plan for everyone. Um.
Speaker 1: Why do you think what's the number one problem right
Speaker 1: now today? You think with the pharmacy business, I mean,
Speaker 1: I think the prices are the obvious problem. Insulin. You know,
Speaker 1: this is something that was discovered in the ninete twenties
Speaker 1: hasn't really changed the prices of insulin are so, and
Speaker 1: insulin is something diabetics need to stay alive. This is
Speaker 1: another case where you know, you can't shop for insulin.
Speaker 1: You can't decide it's too expensive. So, you know, I
Speaker 1: interviewed one patient to you to say, if I don't
Speaker 1: take my insulin for a few days, I'm going to die.
Speaker 1: Like I'm not, Like this is essentially like taking the
Speaker 1: price of water and tripling it. And they're going to
Speaker 1: get there and telling me and telling me as a patient, like, well,
Speaker 1: you come up with the money for it. You know,
Speaker 1: she's someone who she stays at these jobs she hates
Speaker 1: because she just cannot live her life without health insurance.
Speaker 1: So she her whole career. You know, she told me
Speaker 1: one thing, she went to law school because she felt
Speaker 1: like law was a stable profession because she'd always have
Speaker 1: health insurance. Like that's a crazy way to live. That
Speaker 1: she is making every professional decision, every personal decision her
Speaker 1: life around access to insulin. And so I think, you know,
Speaker 1: when things with pharma, the prices are outrageous in the
Speaker 1: United States, and this comes back to the fact that
Speaker 1: the US is the only country that is not regulating
Speaker 1: the prices. You know, when a pharma company wants to
Speaker 1: go sell a drug in the UK, they sit down
Speaker 1: with this agency called NICE, the National Institute for Clinical Excellence,
Speaker 1: and NICE basically decides, like pharma says, here's how much
Speaker 1: we want to charge. NICE looks at how effective your
Speaker 1: drug is and says, here's how much we're willing to pay,
Speaker 1: and you know, if they can come to an agreement,
Speaker 1: it gets added into the national program. There are some
Speaker 1: drugs where you know, England says no, They're been a
Speaker 1: lot of controversies around certain really expensive cancer treatments that
Speaker 1: the national system in the UK won't cover because they
Speaker 1: just don't think they're worth the money. So there certainly
Speaker 1: are some trade offs that after you made like there
Speaker 1: are some very outraged cancer patients in the UK, you
Speaker 1: say like I want the government to cover this, and
Speaker 1: they're not going to cover it, whereas in the US
Speaker 1: you probably could get coverage for it, but it's going
Speaker 1: to be incredibly expensive. So that's a big trade off
Speaker 1: between a system like ours in a system you know,
Speaker 1: like the UK's. But I would say, at some point
Speaker 1: the drugs and we're at that point they're getting so
Speaker 1: expensive that it's like, yes, you have access to them,
Speaker 1: but if you can't afford them, what does that even
Speaker 1: option when when you when you use insulin as an example,
Speaker 1: when I'm wondering, what is it about their lobbying onto
Speaker 1: the extent that you can talk about that that makes
Speaker 1: them so powerful so affect Yeah, so there's just money.
Speaker 1: I think a lot of its money. I think there
Speaker 1: are these ads that ran during Clinton Care, these um
Speaker 1: Harry and Louise ads that are kind of like burned
Speaker 1: into the memory of anyone who worked in a campaign dollars, Yes,
Speaker 1: campaign dollars, and they really launched like an all out
Speaker 1: of salt on Clinton Care. That really was one of
Speaker 1: the reasons why that was not able to go forward.
Speaker 1: I think eval one on an Obamacare so they didn't
Speaker 1: And this is you know, a theory of government that
Speaker 1: the Obama administration had. The abministration felt like they could
Speaker 1: not survive a pharma on slot. So one of the
Speaker 1: things they did, and they felt the same way about
Speaker 1: the A m A the hospitals. They felt like, if
Speaker 1: these guys line up against us, this won't survive. So
Speaker 1: they got them all to endorse the bill. And that
Speaker 1: was a big trade off because there's sort of you know,
Speaker 1: pharma was not going to endorse the bill that regulated
Speaker 1: drug prices. So they said, Okay, with Obamacare, we are
Speaker 1: not going to regulate drug prices. We'll put a small
Speaker 1: tax on the farm industry. Basically, they created taxes on
Speaker 1: all these industries but didn't regulate their prices, and that
Speaker 1: got them all to sign on. You know, I I
Speaker 1: don't know if the current Democrats operate under that theory
Speaker 1: of governance anymore. I was, you know, just meeting with
Speaker 1: Promilla Jayapaul, who runs the House Progressive Caucus and rolled
Speaker 1: out of Medicare for All bill recently, and she basically
Speaker 1: feels like, you know what, like that, like we are
Speaker 1: beyond that, we are not having farm and where's their bill?
Speaker 1: Like we are doing a bill you know, in goal
Speaker 1: is to piste off farm us, spend as much money
Speaker 1: as you want, like we are ready for it. They
Speaker 1: see a lot of bad outcomes of bringing industry on
Speaker 1: board with your healthcare bill, and kind of a different
Speaker 1: view than Obama did going into the Affordable Care Act.
Speaker 1: Let's assume that everything stays as it is right now,
Speaker 1: and we have at least in Congress, we have a
Speaker 1: Republican Senate in a Democratic House, and the White House
Speaker 1: changes hands. Sanders or whoever, Kamela Harris, whoever in the
Speaker 1: White House. What kind of plan do you think there's
Speaker 1: a chance we can end up with or I think
Speaker 1: you see a lot of like the assault in the
Speaker 1: Affordable Care Act, they probably redo some of the stuff
Speaker 1: you can do through the executive branch. Try and shore
Speaker 1: that up. It's going to be hard to do these
Speaker 1: sort of things through executive action, you know, it is
Speaker 1: going to be hard without having the Senate. It is
Speaker 1: hard to do a half ast version a weird idea
Speaker 1: I've heard floated, which like seems to engender a lot
Speaker 1: of lawsuits. It is much easier to just lower the
Speaker 1: eligibility age of Medicare from six to zero, which is
Speaker 1: like very odd way to do this, Like a lot
Speaker 1: of benefits would be missing that It's like not the
Speaker 1: Sanders plan, But I guess that would be like a
Speaker 1: version of this um that could be done without as
Speaker 1: much legislating. But I think it's going to be hard
Speaker 1: and divided government to move forward on this um. I
Speaker 1: think it's it's a big idea that gets a little
Speaker 1: bit stuck in the wheels of Congress. Are you someone
Speaker 1: who you think it's essential that we have to have
Speaker 1: a tax increase in order to afford that we do.
Speaker 1: I mean, we need to get the money from somewhere.
Speaker 1: And you know, if you've talked to Bertie Sanders about this,
Speaker 1: he'll say, yes, there'd be a tax increase, but also
Speaker 1: nobody would be paying their health insurance premiums anymore. So
Speaker 1: you know, the things is getting changed out of your paycheck.
Speaker 1: You're taking out of your paycheck, just get changed a
Speaker 1: little bit. But I think that is where these programs
Speaker 1: run into a lot of challenges. There's this guy at Harvard.
Speaker 1: His name is Williams. Show, and he's kind of like
Speaker 1: if you're a country who wants to build single payer,
Speaker 1: he's like the health economist you call. And when I've
Speaker 1: interviewed him, he's worked without a dozen countries and he
Speaker 1: says about half of them fail. And the reason they
Speaker 1: fail is always the step of how do you pay
Speaker 1: for the thing? Like you can come up with a
Speaker 1: really cool system, but the place where it always gets
Speaker 1: hard is like figuring out, Okay, how do we pay
Speaker 1: for that system. Do you think that healthcare is at
Speaker 1: a crisis in this country right now? Yes, I think,
Speaker 1: And what qualifies I think what qualifies it as a
Speaker 1: crisis as you have people still going into really significant
Speaker 1: crippling debt to afford healthcare that they can't say no to.
Speaker 1: Like I look at the example of insulin, like that
Speaker 1: seems like a crisis to me, that people that there
Speaker 1: are reported stories of people dying because they cannot afford
Speaker 1: their insulin, Like that feels like it's something fair to
Speaker 1: call a crisis. Um, what's next for you? What are
Speaker 1: you working on now? I just know I need to
Speaker 1: stop reading emergency room bills? Which country has the worst
Speaker 1: health care system as far as you're concerned, Oh god,
Speaker 1: I mean, I think we developed countries. It's got to
Speaker 1: be the US, right, Like we if you look at
Speaker 1: any rankings were always incredible, just incredible. The United States
Speaker 1: healthcare system or Hodgepodge of systems, ranks the worst in
Speaker 1: the developed world. We spend the most for the worst outcomes.
Speaker 1: The United Kingdom spends literally half the amount per person
Speaker 1: as the United States and fares better on hospital safety,
Speaker 1: on many disease outcomes, on infant mortality, preventative care, and more.
Speaker 1: Brits even live two years longer than Americans. You can
Speaker 1: find Sarah Cliffs reporting, including her fabulous frustrating emergency room
Speaker 1: billing project at vox dot com. Her podcast, telling the
Speaker 1: human stories behind healthcare policy is called The Impact. This
Speaker 1: is Alec Baldwin and you're listening to hear is the
Speaker 1: Thing four for