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Speaker 1: It's that time time, time, time, Luck and Load.

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Speaker 2: Michael Verie Show is on the air. Professor Charles Silvery

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Speaker 2: as our guest.

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Speaker 1: He's a professor at the University of Texas School of Law,

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Speaker 1: which I happened to believe is fantastic because I'm a

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Speaker 1: graduate of same. His book is Overcharged, Why Americans pay

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Speaker 1: too much for healthcare. You mentioned that the problem began

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Speaker 1: with Medicare Medicaid in the sixties, part of Lyndon Johnson's

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Speaker 1: Great Society, which turned out not to be. It was

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Speaker 1: two point zero of FDRs taking over of the American

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Speaker 1: economy and it's hard to strip that back out of

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Speaker 1: life when Medicare got involved. So my dad's eighty four,

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Speaker 1: my mom recently passed, and I go in and review

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Speaker 1: every expense, everything that comes in and all that this

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Speaker 1: whole Medicare thing. I have a show sponsor called Senior

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Speaker 1: Health Services dot Com, and he and his team help

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Speaker 1: people who are trying to navigate Medicare. And every day

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Speaker 1: I get someone who emails me and says, can you

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Speaker 1: connect me with them? And I forward it and sometimes

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Speaker 1: I stay involved for a little while just to see,

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Speaker 1: you know, kind of what they're working through. It's amazing

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Speaker 1: to people that all of a sudden, I guess when

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Speaker 1: you turn sixty five, you're getting robocalls and junk mail

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Speaker 1: and all this Medicare and Medicare, Medicare, and people had

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Speaker 1: no idea, And now, all of a sudden, I've been,

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Speaker 1: you know, dumped into the Medicare playground. And I don't

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Speaker 1: know why, how does this even work?

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Speaker 3: Too well?

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Speaker 4: I just I recently hit that age myself, so I

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Speaker 4: can sympathize with those whose mailbox are crammed with Medicare

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Speaker 4: vantage flyers and things of that sort. I'm sick of

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Speaker 4: seeing them. And I'm not even using Medicare. I'm still working,

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Speaker 4: so I'm staying on my employer's healthcare system or healthcare insurance,

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Speaker 4: although that is very expensive and far too comprehensive. You know,

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Speaker 4: it's because of the mandates regarding what employer sponsored coverage

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Speaker 4: has to conclude that I wind up paying, you know,

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Speaker 4: way too much. Everybody does pay way too much for insurance.

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Speaker 4: But you know, Medicare, what can I say? It's a

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Speaker 4: program that was designed to succeed by massively inflating the deficit.

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Speaker 4: You know, everybody thinks that Medicare is something that you

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Speaker 4: earn over the course of your lifetime. We don't think

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Speaker 4: of it as welfare, and politicians who refer to it

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Speaker 4: as welfare are excoriated. But the amount that people pay

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Speaker 4: into Medicare is way, way, way smaller than the amount

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Speaker 4: that they get out for most people. Now they're obviously

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Speaker 4: accept to that, but for most people, the way that

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Speaker 4: the program succeeds is by charging them less than the

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Speaker 4: benefits that they will get out of the system.

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Speaker 3: Well, you know, that's a nice arrangement.

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Speaker 4: I'd like to have that, But the problem is somebody.

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Speaker 4: The money to pay for all those benefits has to

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Speaker 4: come from somewhere, and in only only two sources. One

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Speaker 4: is general tax revenue, so they use money in addition

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Speaker 4: tax revenue in addition to the employee tax to fund

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Speaker 4: the program. And the other is deficit spending. And every

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Speaker 4: one of these expansions of the Medicare program is funded

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Speaker 4: through the deficit. So you know, back when Bush two

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Speaker 4: was president, right he created Medicare part D, the prescription

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Speaker 4: Drug Benefit Program. Well, the premiums even initially for that program,

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Speaker 4: we're only set at fifty percent of the estimated cost.

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Speaker 4: Now they're down to twenty five percent of the estimated cost,

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Speaker 4: which means everybody loves Medicare party because it's a great deal. Right,

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Speaker 4: I'm only paying twenty five percent of the cost. But

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Speaker 4: what you're really doing is taking the cost of prescription

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Speaker 4: drugs and rolling them into the deficit. And the same

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Speaker 4: thing goes for Obamacare with all these premium subsidies. Everything

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Speaker 4: that the government does is designed to be popular by

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Speaker 4: being priced below its actual cost, and the result of

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Speaker 4: that in the long run has to be deficit increases

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Speaker 4: and inflation increases.

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Speaker 3: There's just no getting around that.

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Speaker 1: It's frustrating because then Medicare, the government is telling you

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Speaker 1: which doctors you can go to and which you can't,

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Speaker 1: which procedures you can do in which you can't, and

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Speaker 1: so you know, and look, it sounds like.

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Speaker 2: You and I are relatively aligned.

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Speaker 1: I was an acolyte of Professor Leino Graia, so you

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Speaker 1: probably understand where my views are with regard to politics

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Speaker 1: and the role of the government and the individual. Probably

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Speaker 1: more libertarian certainly than he was. I'm over on the

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Speaker 1: Rand and Ron Paul end of things. But what I

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Speaker 1: find frustrating is that people seem to think that somehow

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Speaker 1: government is protecting you and aiding you. But in fact,

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Speaker 1: what goes with that is, you know why you don't

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Speaker 1: feed the bears at the zoo, is they're controlling you,

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Speaker 1: and any government powerful enough to pay for your medical

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Speaker 1: surgery or medical procedures, powerful enough to take it away,

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Speaker 1: and then they start making decisions for you. And that's

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Speaker 1: where we get into the civil liberties. And that's where

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Speaker 1: I get very frustrated, because we've now moved beyond healthcare

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Speaker 1: and we've moved into a sort of totalitarian authoritarian control

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Speaker 1: of the individual.

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Speaker 4: Well, you're certainly singing my song because you know you're

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Speaker 4: a libertarian. I'm an adjunct scholar at the Cato Institute.

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Speaker 4: I don't think it gets much more libertarian than that,

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Speaker 4: I would say, so, so we're on the same page

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Speaker 4: as far as you know, being very very concerned about

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Speaker 4: the governmental control. I think that governmental control is part

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Speaker 4: of the story, but I think governmental ineptitude is probably

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Speaker 4: a much bigger part of the story. You know, I'm

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Speaker 4: willing to say, oh, some of those you know, bureaucrats

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Speaker 4: who run these programs actually want to want to help people,

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Speaker 4: and may even believe they are helping people, But it's

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Speaker 4: actually very difficult to run the healthcare system. Well, that's

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Speaker 4: why market forces are so important, because market forces are

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Speaker 4: constantly rewarding providers for figuring out how to serve patients better.

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Speaker 3: Right, that's how you can get business.

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Speaker 4: If you can figure out how to serve your customers better,

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Speaker 4: then you'll get more customers. And that's just something that

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Speaker 4: requires people who know the nuts and bolts really well

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Speaker 4: to be constantly reflecting on.

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Speaker 3: How they're doing their jobs. Right.

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Speaker 4: The government bureaucrats, they don't do that. They don't even

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Speaker 4: know how the jobs work. They just exist mainly to

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Speaker 4: pay bills and to enact regulations that enable them to

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Speaker 4: deal with the burden that all this imposes on the

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Speaker 4: federal government. And the results for consumers are just terrible.

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Speaker 4: You know, all these problems that everybody complains about, prior

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Speaker 4: authorization requirements, surprise bills, these things called facility fees that

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Speaker 4: you know, you go to an emergency room, the doctor says, oh,

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Speaker 4: you've got a fever, take some aster and go home,

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Speaker 4: and then you get a bill for ten thousand dollars

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Speaker 4: because you literally because you walked in the front doors.

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Speaker 4: It's just like a cover charge at a bar. Or

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Speaker 4: something like that, except a lot bigger. You know, none

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Speaker 4: of that stuff exists in the direct payment system. It

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Speaker 4: all exists because the government regulates the way healthcare is delivered,

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Speaker 4: and it does it in stupid ways because it's hard

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Speaker 4: to do it right.

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Speaker 1: And government's not in the business of efficiency. Professor Charles

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Speaker 1: Silver is our guest. The book is Overcharged, Why you

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Speaker 1: Americans pay too much for healthcare?

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Speaker 3: And listen to the Michael Berry Show.

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Speaker 1: Good that. Professor Charles Silver of the University of Texas

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Speaker 1: School of Law is our guest. He was I have

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Speaker 1: come to learn in the course of our conversation at

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Speaker 1: ut Law almost ten years before I was there and

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Speaker 1: still is. I did not know him, but I happened

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Speaker 1: to think the world of that law school, and I

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Speaker 1: gained a lot from being there, both associations and education.

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Speaker 1: And this book has been highly recommended to me by

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Speaker 1: numerous folks as to how to gain a better un

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Speaker 1: understanding of why the healthcare system costs you so much. Overcharged,

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Speaker 1: Why Americans pay too much for healthcare? Professor Charles Silver

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Speaker 1: is our guest. Professor, let's talk about young people. By

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Speaker 1: young I'm fifty three, so I'm gonna throw myself into there.

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Speaker 1: You know, I've read that something like half the healthcare

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Speaker 1: costs in this country are expended on people within the

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Speaker 1: last two years of their lives. And you know, we

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Speaker 1: see this where it's just constant. It's just one thing

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Speaker 1: after another after another, and then they pass and then

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Speaker 1: you kick in the funeral industry, and I mean it's

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Speaker 1: these are all industries, like the bridal industry and the

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Speaker 1: birthing industry. When you look at a person who is

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Speaker 1: relatively healthy without a chronic condition, and you're looking at

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Speaker 1: the cost to them that they're bearing, which really is

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Speaker 1: the risk you're willing to assume. Right, if you're never

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Speaker 1: going to need a doctor, then you don't need insurance.

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Speaker 1: We just don't know which one one of us is

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Speaker 1: going to be in a car wreck or have a

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Speaker 1: heart attack. So we're trying the same way we leverage

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Speaker 1: the risk on if our house burns down. We're trying

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Speaker 1: to kind of to keep that at bay and to

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Speaker 1: make a good financial decision. Where is that going wrong today?

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Speaker 1: Because my guess is most people are overpaying for insurance

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Speaker 1: coverage that they won't need until much later.

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Speaker 2: That's going toward people at their end of life.

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Speaker 4: Oh, I agree that I think that story is right.

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Speaker 4: There are a bunch of thoughts that it prompts. One

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Speaker 4: of them is, you know, I've never been a fan

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Speaker 4: of taxing people who are relatively young to provide benefits

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Speaker 4: to people who are relatively old. That strikes me as

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Speaker 4: wrong on a variety of levels.

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Speaker 3: You know.

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Speaker 4: One is, every moral theory that I know of says

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Speaker 4: you move money from.

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Speaker 3: Richer people to poorer people.

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Speaker 4: Well, older people are wealthier than younger people. That shouldn't

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Speaker 4: be surprising to anybody. They've had their whole lives to

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Speaker 4: work right and saved. They've paid off their cars, they've

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Speaker 4: paid off their homes. You know, they have other assets. Right,

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Speaker 4: They're on average, much wealthier than younger people who are struggling,

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Speaker 4: you know, raising families, you know, just getting jobs, dealing

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Speaker 4: with college debt and all that stuff. So my moral

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Speaker 4: view is if we were going to move money in

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Speaker 4: any direction, we should move it from older people to

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Speaker 4: younger people. But our system does the reverse. We're robbing

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Speaker 4: the poor to pay the rich. I don't understand that.

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Speaker 4: Another thing is, excuse me, the system really deserves people

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Speaker 4: because it eliminates all caps on spending you were talking

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Speaker 4: about end of life care and how we spend so

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Speaker 4: much money in the last year or two of people's lives.

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Speaker 3: Well, if people.

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Speaker 4: Had to spend their own money, nobody would spend an

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Speaker 4: infinite amount in their last two years on healthcare. Have

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Speaker 4: to make hard decisions, right, These are not pleasant decisions,

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Speaker 4: but they would make decisions about how much healthcare they want.

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Speaker 4: Is it worth spending a million dollars to extend my

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Speaker 4: life by a month, Right, that's the kind of decision

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Speaker 4: they would have to make. Well, today, because we removed

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Speaker 4: all caps from the system, nobody has to make those decisions. Instead,

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Speaker 4: we just spend literally an infinite amount of money on

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Speaker 4: people who are in the final stages of their illness.

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Speaker 4: We get no bang for the buck. You know, we

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Speaker 4: have people, literally we have people who are receiving cancer treatments,

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Speaker 4: new cancer treatments that cost a million dollars, and all

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Speaker 4: those treatments do is extend their lives by about a month.

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Speaker 4: And it's not even a good month. It's not a

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Speaker 4: month when you're going to be out there on the

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Speaker 4: golf course playing with your buddies and drinking beer. It's

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Speaker 4: a month like you're in the hospital right for the

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Speaker 4: whole month. These things just make no sense. Right, But

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Speaker 4: the government cannot make those decisions, literally, it cannot because

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Speaker 4: the moment the government starts talking about rationing care, everybody

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Speaker 4: loses their minds and you don't want to be the

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Speaker 4: politician that they're rallying against. Right, So the government simply

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Speaker 4: ignores the need to make these decisions and just spends

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Speaker 4: endless amounts of money because it's other people's money. So

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Speaker 4: why does the government care?

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Speaker 3: Right? And you know, we just have to come.

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Speaker 4: Back to the world in which people are responsible for

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Speaker 4: their own end of life care. You know, it's a

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Speaker 4: sad thing, but it's true. We will all die at

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Speaker 4: some point, and the fact that we will all die

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Speaker 4: at some point affects a thousand decisions that each of

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Speaker 4: us makes. Right, When am I going to stop working? Well,

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Speaker 4: if I'm thinking I don't have much longer to live,

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Speaker 4: it probably will stop working so I can spend my

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Speaker 4: last you know, couple of years with my family or

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Speaker 4: traveling or whatever it is, right, I mean, if you

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Speaker 4: start to think about it, knowing that at some point

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Speaker 4: we will all die, it affects, as I said, thousands

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Speaker 4: of decisions that we make. You know, do I want

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Speaker 4: to live in this house that I'm in now until

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Speaker 4: the end of my life, or do I want to

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Speaker 4: move to a house that's more handicap equipped and things.

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Speaker 3: Of that sort.

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Speaker 4: Right, this is just another decision. It's a tough decision.

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Speaker 4: I'm not trying to say otherwise, but it's a decision

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Speaker 4: that needs to be made, and it needs to be

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Speaker 4: made not by the government, but by the people who

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Speaker 4: are directly involved and who can think hard about all

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Speaker 4: these tough problems. There's no way the government's going to

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Speaker 4: make a good decision. Their incentives are wrong, their knowledge

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Speaker 4: is too limited. They don't have access to the counselors

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Speaker 4: that individuals will talk to when making these kinds of decisions. So,

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Speaker 4: you know, we just have to get the government out

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Speaker 4: of this business. What I have proposed is, you know,

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Speaker 4: there is one other problem though that we haven't discussed,

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Speaker 4: which we do need to discuss, which is there are

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Speaker 4: some people who are too poor to afford fundamental health care.

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Speaker 4: We do need to come up with a way of

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Speaker 4: dealing with those people, because when they show up at

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Speaker 4: the hospital needing healthcare, they're not going to be turned away, right,

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Speaker 4: And we're not going to be having sick people dying

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Speaker 4: in the streets because they can't afford healthcare. So we

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Speaker 4: need to come up with a way to deal with that.

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Speaker 4: But the obvious way to deal with that is through

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Speaker 4: a negative income tax, the sort of thing that Milton

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Speaker 4: Friedman proposed. You know, you provide everybody with a kind

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Speaker 4: of amount of sustenance that they can use for this purpose.

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Speaker 4: You could put it into a restricted medical account if

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Speaker 4: you wanted. But the idea is once you give it

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Speaker 4: to them, it's hands off for the rest of it.

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Speaker 4: The government doesn't get involved in the delivery of healthcare.

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Speaker 3: It just people make.

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Speaker 4: Decisions on themselves with their own money, and life goes forward.

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Speaker 4: And I think if we did that, the healthcare system

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Speaker 4: would operate much more efficiently.

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Speaker 1: Well, the great frustration, as you know, is that everybody

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Speaker 1: gets a vote, even people that make bad decisions, and

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Speaker 1: that many people make bad decisions. You know that we

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Speaker 1: will have a lot of people who say I can't

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Speaker 1: afford medical care because they don't save money.

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Speaker 2: But they've got a big screen TV in every.

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Speaker 1: Room, and they've gotten, you know, a car they can't

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Speaker 1: afford that they're driving.

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Speaker 2: They end up with the car that they can't afford,

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Speaker 2: and we end up paying for the healthcare that they

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Speaker 2: can't afford.

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Speaker 1: The book is Overcharged, Why Americans Pay Too Much for Healthcare?

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Speaker 2: Professor Charles Silver more and everybody knows who this guy is.

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Speaker 4: Come on, man with them, Michael Barry, come on.

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Speaker 1: Professor Charles silver is our guest. It's a subject of

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Speaker 1: great interest to me and to many of you. The

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Speaker 1: book is called Overcharged, Why Americans Pay Too Much for Healthcare?

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Speaker 1: He is a law professor at the University of Texas,

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Speaker 1: at Austin of Law. And we ended the last segment

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Speaker 1: with the discussion that at the end of the day,

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Speaker 1: the allocation of scarce resources and who will make that decision.

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Speaker 1: We're back at that point again in every family. You know,

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Speaker 1: you got eight kids and you've got one chicken. Mom

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Speaker 1: says you're not getting a second piece. So there's some

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Speaker 1: cartilage left on that leg.

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Speaker 2: If you're hungry, you'll eat that.

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Speaker 1: And there comes a point where we have to decide

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Speaker 1: with scarce resources, who will make the decision as to

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Speaker 1: where those resources will be deployed. Will it be the

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Speaker 1: government or will it be the individual? And if it's

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Speaker 1: the individual, there will be those who say, well, I

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Speaker 1: want as much as my neighbor has, Okay, we'll earn

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Speaker 1: the money to purchase that. Well, I don't earn as much.

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Speaker 1: I want to use the power of the gun through

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Speaker 1: at the direction of the government that I either more

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Speaker 1: of me than there are of the rich people I

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Speaker 1: vote for. I want that well. The only alternative is

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Speaker 1: for the government to do it. Professor I harkened back

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Speaker 1: to a study. And it's been a while since I

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Speaker 1: read this book. It's interesting because I'm a believer and

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Speaker 1: let the marketplace decide. You know, healthcare is a one

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Speaker 1: area where we think everybody gets all the healthcare they want,

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Speaker 1: but we all end up paying for that. We don't

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Speaker 1: say everybody gets all the food they want, or all

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Speaker 1: the cars they want, or all the houses they want,

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Speaker 1: or all the clothes they want, but for some reason,

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Speaker 1: everybody gets all the healthcare they want, even at the

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Speaker 1: point that it's throwing good money after bad. So socialist

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Speaker 1: system the opposite of what I propose. In Sweden, they

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Speaker 1: did a study, and it was a multi decade study,

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Speaker 1: you may be aware of it, on prostate cancer in men,

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Speaker 1: and they determined that out of I think it was

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Speaker 1: three thousand men who had prostate cancer, who were diagnosed

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Speaker 1: with prostate cancer, and they chose not to treat the

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Speaker 1: prostate cancer. And they did about a twenty five year

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Speaker 1: study and the number of men who died of untreated

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Speaker 1: prostate cancer was something like thirty out of three thousand.

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Speaker 1: So they came to the conclusion with a government, completely

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Speaker 1: government run system, that with scarce resources, it does not

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Speaker 1: make sense for us to treat prostate cancer per se

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Speaker 1: because nobody, very few people are going to die of

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Speaker 1: prostate cancer. Let's spend our money on other things that

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Speaker 1: if we don't spend it there, you die. And it

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Speaker 1: strikes me that while that's the opposite of the capitalist system,

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Speaker 1: there does need to be an understanding that we're wasting

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Speaker 1: a lot of money on studies because and this gets

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Speaker 1: to the second point of what you've written a lot

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Speaker 1: about medical malpractice and the fear of medical malpractice. I

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Speaker 1: don't think everybody needs a glaucoma test every time they

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Speaker 1: go for their license, but God forbid one person not

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Speaker 1: be diagnosed with glaucoma. We're practicing defensive medicine. We're over

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Speaker 1: ordering tests, which is a waste of our time and energy.

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Speaker 1: But also money, and we're not actually doing We're not

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Speaker 1: engaged in what I would consider smart effective healing because

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Speaker 1: everyone is afraid of being sued. And that has we

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Speaker 1: get back to our point. The book is overcharged. Why

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Speaker 1: Americans pay too much for healthcare? I think that's a

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Speaker 1: big portion of what we spend.

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Speaker 4: Your thought, well, I'm going to disagree with part of that,

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Speaker 4: but I agree with a lot of it as well.

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Speaker 4: In my world, when you have a self interested explanation

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Speaker 4: or something, you probably don't have to look very far

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Speaker 4: for any other explanation. Self interest usually is a pretty

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Speaker 4: good explanation. And the reason, you know, some people say, oh,

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Speaker 4: the reason that doctors overtreat is because they're afraid of

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Speaker 4: being sued. Well, there's a simpler self interested explanation, which

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Speaker 4: is every time they treat somebody, they make money, and

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Speaker 4: until you take the profit out of these services, which

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Speaker 4: will never happen, it's very hard to determine that they're

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Speaker 4: actually engaging in any real defensive medicine at all. There

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Speaker 4: are lots of studies that are out there now that

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Speaker 4: have found that, I mean, defensive medicine is kind of

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Speaker 4: hard to define because it can be both, it can

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Speaker 4: be both the provision of services that aren't needed and

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Speaker 4: the avoidance of services that are needed, because you get

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Speaker 4: sued when you do deliver services as well as when

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Speaker 4: you withhold them. So it's hard to figure out exactly

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Speaker 4: what's going on with defensive medicine. But as I said,

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Speaker 4: I don't think we really need to worry about it

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Speaker 4: very much because we have a self interested explanation, which

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Speaker 4: is that the services are profitable. And there's also you know,

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Speaker 4: doctors have a lot of confidence in their ability to

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Speaker 4: help people, and they have a very strong desire to

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Speaker 4: help people.

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Speaker 2: Right it should you know?

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Speaker 1: You remind me of another great document written in seventeen

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Speaker 1: seventy six, and that from a Scotsman named Adam Smith,

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Speaker 1: who famously said, it is not from the benevolence of

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Speaker 1: the butcher, or the brewer or the baker that we

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Speaker 1: expect our dinner, but from their regard to their own

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Speaker 1: self interest. And exactly self interest drives so many things.

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Speaker 1: That guy is not standing on his feet behind the

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Speaker 1: counter at the donut shop for so many hours and

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Speaker 1: didn't get there at two thirty this morning because he's

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Speaker 1: a nice guy. He wants to make a profit off

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Speaker 1: the donuts. I get to enjoy the donuts in exchange

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Speaker 1: for the currency that I was given for the sweat

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Speaker 1: of my brow. It works, and I think we have

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Speaker 1: to return that to the process. And I think that's

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Speaker 1: where you and I can agree.

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Speaker 4: I think we do agree on that, but we also

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Speaker 4: agree that I mean, these social programs have fundamentally undermined

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Speaker 4: the incentive to say and to be self reliant, you know,

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Speaker 4: the I think you know, I constantly read articles about

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Speaker 4: how many people are retiring and all they have to

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Speaker 4: live on is social security and medicare They don't have

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Speaker 4: much in the way of savings. And people say, well,

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Speaker 4: how could you possibly, you know, let that happen?

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Speaker 3: Right?

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Speaker 4: Why are you buying, as you put it, those you know,

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Speaker 4: big screen TVs for every room when you should be

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Speaker 4: saving for your later years. I think the answer is

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Speaker 4: that most people naively think, oh, the government's just going

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Speaker 4: to take care of me in my later years, so

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Speaker 4: I don't have to save, and they, you know, the

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Speaker 4: temptation to spend money now rather than later, it's always there.

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Speaker 4: Who wants to save? Saving is boring?

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Speaker 3: Right?

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Speaker 4: Consuming today is fun? So, you know, I think that

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Speaker 4: as long as we have these paygo programs where you

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Speaker 4: know you can keep getting money out above what you

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Speaker 4: put in, that the incentives to save will forever be undermined.

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Speaker 4: And that's a terrible thing, I think, because, as you said,

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Speaker 4: you know, we're just getting ourselves into this world where

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Speaker 4: each of us expects everybody else to pay for everything

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Speaker 4: that we need. If it's only healthcare, they still expect

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Speaker 4: to pay for everything that they want, and that just

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Speaker 4: drives costs through the roof without really any offsetting benefits

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Speaker 4: that make sense of it.

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Speaker 1: Zoologists will tell you you are doing great harm by

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Speaker 1: domesticating certain breeds of animals, particularly if you intend at

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Speaker 1: some point to release them into the wild.

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Speaker 2: You make them slaves.

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Speaker 1: They lose the very abilities, and we've seen with evolutionary

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Speaker 1: studies that teeth are not as sharp any longer, claws

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Speaker 1: are not as sharpenning more, they can no longer run

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Speaker 1: as fast. They grow to be like prison inmates, dependent

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Speaker 1: on someone else to provide for them, and I think

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Speaker 1: that has to be unders good by people. Our guest

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Speaker 1: is Professor Charles Silver, who would be with us for

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Speaker 1: one more segment. The book is Overcharged, Why Americans pay

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Speaker 1: too much for us that's it.

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Speaker 3: Arrest me or take me to Texas. So talking about

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Speaker 3: to get out of this state.

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Speaker 4: I think Michael Barry roths Michael very show.

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Speaker 1: I like you. Professor Charles Silver of the University of

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Speaker 1: Texas School of Law, my alma mater, has graciously spent

437
00:25:28,560 --> 00:25:31,520
Speaker 1: quite a bit of time with us discussing an area

438
00:25:31,680 --> 00:25:34,560
Speaker 1: of his academic expertise and prowess.

439
00:25:34,920 --> 00:25:35,520
Speaker 2: The book is.

440
00:25:35,520 --> 00:25:39,000
Speaker 1: Overcharged, why Americans pay too much for healthcare? And folks,

441
00:25:39,359 --> 00:25:42,040
Speaker 1: I have to say, as you've heard me say many times,

442
00:25:43,480 --> 00:25:47,480
Speaker 1: politics is interesting, you know, the rooting for your team

443
00:25:47,600 --> 00:25:50,919
Speaker 1: versus that team, the Trump Dance, the reds and Blues,

444
00:25:50,960 --> 00:25:54,200
Speaker 1: and who shows up and on. But my primary interest

445
00:25:54,280 --> 00:25:56,320
Speaker 1: at the end of the day is not my team

446
00:25:56,359 --> 00:25:59,920
Speaker 1: winning and your team losing. My primary interest is create

447
00:26:00,280 --> 00:26:04,480
Speaker 1: a structure where the individual can thrive, where there is

448
00:26:04,720 --> 00:26:10,440
Speaker 1: opportunity and fairness, safeguard's rule of law, and that will,

449
00:26:10,520 --> 00:26:14,000
Speaker 1: at the end of the day, advance humanity. It always has.

450
00:26:14,040 --> 00:26:16,640
Speaker 1: It's the only thing that does not government. And so

451
00:26:16,720 --> 00:26:21,080
Speaker 1: these sort of policy discussions, I understand are probably less

452
00:26:21,119 --> 00:26:25,240
Speaker 1: thrilling than my usual screaming and hollering about this or

453
00:26:25,280 --> 00:26:28,440
Speaker 1: that indignity of the day. But this is what matters.

454
00:26:28,680 --> 00:26:32,600
Speaker 1: This is why we get involved in campaigns, is to

455
00:26:32,680 --> 00:26:34,600
Speaker 1: take control of the government and get it out of

456
00:26:34,640 --> 00:26:39,040
Speaker 1: our lives and create safeguards and reduce regulation and promote

457
00:26:39,040 --> 00:26:42,000
Speaker 1: the rule of law so that hardworking people can create

458
00:26:42,119 --> 00:26:45,000
Speaker 1: enough John Gault style for the rest of us to prosper.

459
00:26:45,520 --> 00:26:50,040
Speaker 1: And this stuff matters. So that's why we have these conversations.

460
00:26:50,520 --> 00:26:55,200
Speaker 1: Professor Charlesolver, overcharged, why Americans pay too much for healthcare?

461
00:26:55,600 --> 00:26:58,320
Speaker 1: Professor Silver, I want you to be king for a day.

462
00:26:58,440 --> 00:26:59,120
Speaker 2: You have no.

463
00:27:00,960 --> 00:27:07,480
Speaker 1: As this benevolent monarch, you have no political concerns. Reconstruct

464
00:27:07,760 --> 00:27:11,679
Speaker 1: our health care facility to provide an opportunity for the

465
00:27:11,680 --> 00:27:15,440
Speaker 1: most healing to occur and the individuals to take control

466
00:27:15,560 --> 00:27:16,639
Speaker 1: of their own healthcare.

467
00:27:16,720 --> 00:27:17,560
Speaker 2: What does that look like?

468
00:27:20,119 --> 00:27:23,320
Speaker 4: Wow, I'm nervous about being king for a day because

469
00:27:23,640 --> 00:27:25,120
Speaker 4: I don't believe in kings.

470
00:27:24,960 --> 00:27:25,760
Speaker 2: I know, but I know.

471
00:27:27,200 --> 00:27:27,720
Speaker 3: I'll try.

472
00:27:29,640 --> 00:27:33,399
Speaker 4: I think we basically wipe away everything in terms of

473
00:27:34,240 --> 00:27:39,000
Speaker 4: these programs and the restrictive regulations. You know, have you

474
00:27:39,000 --> 00:27:40,960
Speaker 4: ever heard of a certificate of need law?

475
00:27:41,160 --> 00:27:41,560
Speaker 3: I don't know.

476
00:27:41,800 --> 00:27:46,040
Speaker 4: They're called con laws by for short, but con laws

477
00:27:47,800 --> 00:27:52,560
Speaker 4: regulate how many new healthcare providers can set up shops.

478
00:27:52,560 --> 00:27:54,480
Speaker 4: So if you want to open the hospital, you got

479
00:27:54,480 --> 00:27:57,360
Speaker 4: to get permission. Oh okay, I guess what the way

480
00:27:57,400 --> 00:28:01,639
Speaker 4: the con laws work. The existing high hospitals have a

481
00:28:01,720 --> 00:28:04,159
Speaker 4: vote and whether you can open a new hospital, or

482
00:28:05,080 --> 00:28:08,879
Speaker 4: like giving McDonald's a vote on whether Burger King can

483
00:28:08,920 --> 00:28:12,760
Speaker 4: open a restaurant right across the street. It just doesn't

484
00:28:12,800 --> 00:28:15,159
Speaker 4: make any sense, but that's the way I would get

485
00:28:15,280 --> 00:28:19,359
Speaker 4: rid of all of those supply constraining regulations, and I

486
00:28:19,400 --> 00:28:24,760
Speaker 4: would get rid of all of these programs Obamacare, Medicare, whatever,

487
00:28:25,600 --> 00:28:31,240
Speaker 4: and I would go to a very simple wealth distribution program.

488
00:28:31,359 --> 00:28:33,679
Speaker 4: I'm not sure exactly how much money it should be.

489
00:28:33,920 --> 00:28:36,040
Speaker 4: That's something that has to have some work done. But

490
00:28:36,080 --> 00:28:38,360
Speaker 4: you know we're currently spending if you put all the

491
00:28:38,440 --> 00:28:44,360
Speaker 4: healthcare programs together, you know, we're spending like seven eight

492
00:28:44,520 --> 00:28:48,160
Speaker 4: ten thousand dollars a person per you know, per American

493
00:28:48,240 --> 00:28:50,880
Speaker 4: through these programs. If we just took some of that

494
00:28:51,040 --> 00:28:56,800
Speaker 4: money and started plunking it into restricted healthcare savings accounts

495
00:28:56,800 --> 00:28:59,080
Speaker 4: for people, so every year, you know, there's just a

496
00:28:59,160 --> 00:29:02,480
Speaker 4: little bit more that's put in. Pretty soon everybody would

497
00:29:02,520 --> 00:29:05,440
Speaker 4: have enough money to pay for their basic needs and

498
00:29:05,520 --> 00:29:08,720
Speaker 4: to buy catastrophic insurance, and I would let people buy

499
00:29:09,520 --> 00:29:13,240
Speaker 4: just as much catastrophic insurance as they want. I wouldn't

500
00:29:13,280 --> 00:29:16,400
Speaker 4: have coverage mandates. You know, right now, if you want

501
00:29:16,440 --> 00:29:19,239
Speaker 4: to buy a policy on one of the exchanges and

502
00:29:19,280 --> 00:29:24,480
Speaker 4: you're a young man, you know you have to pay

503
00:29:24,520 --> 00:29:29,600
Speaker 4: for annual mammograms, right, but you're not getting mamograms because

504
00:29:29,640 --> 00:29:33,440
Speaker 4: you're a man, right right, So you know, I wouldn't

505
00:29:33,480 --> 00:29:36,920
Speaker 4: force people to buy any particular amount of coverage, and

506
00:29:36,960 --> 00:29:41,200
Speaker 4: I would let insurance companies limit the total payouts, which

507
00:29:41,800 --> 00:29:45,719
Speaker 4: you know, that's really where things are screwed up right now.

508
00:29:45,760 --> 00:29:47,440
Speaker 4: It's one of the areas, right they have to spend

509
00:29:47,560 --> 00:29:49,440
Speaker 4: unlimited amounts of money on people.

510
00:29:50,000 --> 00:29:51,200
Speaker 3: I would let people let.

511
00:29:51,160 --> 00:29:55,880
Speaker 4: Design their own insurance programs. And I think that you know,

512
00:29:55,920 --> 00:29:58,600
Speaker 4: it's not going to work perfectly. Nothing ever works perfectly, right,

513
00:29:58,680 --> 00:30:01,560
Speaker 4: but it would work so much better and be so

514
00:30:01,680 --> 00:30:04,880
Speaker 4: much more efficient than the existing system, and it'd be

515
00:30:05,000 --> 00:30:10,000
Speaker 4: way more consumer friendly. And that's a huge improvement because

516
00:30:10,080 --> 00:30:13,640
Speaker 4: I don't know anybody who is happy with the existing

517
00:30:13,680 --> 00:30:17,360
Speaker 4: healthcare system. I mean, this terrible murder that just occurred

518
00:30:18,520 --> 00:30:24,520
Speaker 4: has brought to the surface the extraordinary hatred that people

519
00:30:24,640 --> 00:30:29,200
Speaker 4: have toward insurance companies. You know, that's just one symptom.

520
00:30:29,360 --> 00:30:33,440
Speaker 4: We're spending twice as much as any other country on healthcare,

521
00:30:34,080 --> 00:30:35,600
Speaker 4: and we're getting less and less.

522
00:30:35,360 --> 00:30:36,720
Speaker 3: Healthy every year.

523
00:30:37,240 --> 00:30:41,240
Speaker 4: You know, our life expectancy is declining. We're just doing

524
00:30:41,280 --> 00:30:44,760
Speaker 4: everything wrong that we possibly can do. So wipe the slate,

525
00:30:45,280 --> 00:30:47,400
Speaker 4: get rid of all this stuff. Start out with a

526
00:30:47,440 --> 00:30:52,440
Speaker 4: really simple direct payment system and a cash transfer system

527
00:30:52,520 --> 00:30:55,000
Speaker 4: to deal with people who are so poor that they

528
00:30:55,000 --> 00:30:59,800
Speaker 4: can't even afford the basics, and just be satisfied with that.

529
00:31:00,000 --> 00:31:01,680
Speaker 4: I said, it's not gonna be perfect, but it'd be

530
00:31:01,680 --> 00:31:04,000
Speaker 4: hard to improve on all, right.

531
00:31:03,920 --> 00:31:08,680
Speaker 1: Yeah, And to get outside the purview of what we've discussed,

532
00:31:08,680 --> 00:31:11,440
Speaker 1: but to speak more to the process that lands us

533
00:31:11,840 --> 00:31:12,560
Speaker 1: where we are.

534
00:31:13,400 --> 00:31:14,680
Speaker 2: Our criminal justice system.

535
00:31:14,720 --> 00:31:19,440
Speaker 1: We spend more on imprisoning and prosecuting and chasing down

536
00:31:19,520 --> 00:31:22,080
Speaker 1: bad guys in any other country in the world, and

537
00:31:22,160 --> 00:31:25,160
Speaker 1: yet I think we do a far worse job, at

538
00:31:25,280 --> 00:31:28,360
Speaker 1: less effective job than most countries in the world. And

539
00:31:28,400 --> 00:31:31,400
Speaker 1: I think much of that can you can see some

540
00:31:31,440 --> 00:31:36,440
Speaker 1: similarities and patterns that pervade those two industries. And by

541
00:31:36,480 --> 00:31:39,560
Speaker 1: the way, then we could move over into public education

542
00:31:39,640 --> 00:31:43,560
Speaker 1: and education generally I mean, there are a number of

543
00:31:43,560 --> 00:31:49,360
Speaker 1: different applications for where this process has gone wrong, and

544
00:31:49,520 --> 00:31:54,680
Speaker 1: it is frustrating. I very much appreciate your time, Professor.

545
00:31:55,600 --> 00:32:00,920
Speaker 1: I feel the better for it. The book is overcharged

546
00:32:01,160 --> 00:32:05,040
Speaker 1: Why Americans pay too much for health care? Professor Charles

547
00:32:05,120 --> 00:32:08,280
Speaker 1: Silver of the University of Texas School of Law.

548
00:32:08,280 --> 00:32:11,240
Speaker 3: Thank you, sir, Thank you, Michael Pleasure.

549
00:32:11,520 --> 00:32:15,160
Speaker 1: And with that, might I suggest to each and every

550
00:32:15,200 --> 00:32:19,120
Speaker 1: one of you that while politics is an interesting undertaking,

551
00:32:19,280 --> 00:32:22,920
Speaker 1: and it is you know, winning elections, and he said this,

552
00:32:23,000 --> 00:32:25,760
Speaker 1: and we're going to show him, and you know, it's

553
00:32:25,800 --> 00:32:29,240
Speaker 1: a battle royale, and you know I argued with my

554
00:32:29,360 --> 00:32:34,480
Speaker 1: cousin at the Thanksgiving table. At the end of it all,

555
00:32:35,160 --> 00:32:41,440
Speaker 1: the reason for the arguments, reason for the elections should

556
00:32:41,560 --> 00:32:50,080
Speaker 1: be very redemptive, very practical, not just existential, not just ideological.

557
00:32:50,120 --> 00:32:51,440
Speaker 2: They're real to your.

558
00:32:51,280 --> 00:32:59,880
Speaker 1: Life, and that is creating a governmental system where individuals

559
00:33:00,120 --> 00:33:05,400
Speaker 1: are free to thrive. Government is not just. Government is

560
00:33:05,480 --> 00:33:09,719
Speaker 1: not merciful. Government is not protective. It is not good.

561
00:33:11,360 --> 00:33:16,680
Speaker 1: Government is clunky, it's inefficient. If you've stood in line

562
00:33:16,680 --> 00:33:19,040
Speaker 1: at the DPS office to get your driver's license and

563
00:33:19,080 --> 00:33:22,600
Speaker 1: thought to yourself, you could move this thing along if

564
00:33:22,600 --> 00:33:26,080
Speaker 1: you've seen someone who is on the clock and doesn't

565
00:33:26,160 --> 00:33:30,520
Speaker 1: care about results, if you've seen the worst of government

566
00:33:30,560 --> 00:33:33,600
Speaker 1: in every aspect, whether it's the inspector who doesn't seem

567
00:33:33,640 --> 00:33:37,560
Speaker 1: to care that they're coming back and adding these regulations

568
00:33:37,560 --> 00:33:39,120
Speaker 1: that are going to cost this much more for you

569
00:33:39,160 --> 00:33:40,680
Speaker 1: to build this, and now you're going to walk away

570
00:33:40,680 --> 00:33:43,320
Speaker 1: from the project and lead the property vacant, and that's

571
00:33:43,400 --> 00:33:45,160
Speaker 1: not good for anybody.

572
00:33:45,360 --> 00:33:47,720
Speaker 2: These are the things that we should spend our time with.

573
00:33:48,880 --> 00:33:53,239
Speaker 1: And I say this because politics has become sport and

574
00:33:53,280 --> 00:33:54,440
Speaker 1: it's become for many.

575
00:33:54,280 --> 00:33:55,600
Speaker 2: People their favorite hobby.

576
00:33:56,000 --> 00:33:58,120
Speaker 1: But let's not lose track of what we're trying to

577
00:33:58,160 --> 00:34:00,880
Speaker 1: do here, which is literal, not to exaggerate.

578
00:34:01,360 --> 00:34:05,320
Speaker 2: Save our coney well, a gentleman. Ellus has left the building.

579
00:34:05,760 --> 00:34:07,400
Speaker 4: Thank you, and good night.

580
00:34:10,680 --> 00:34:10,719
Speaker 3: H