1 00:00:11,160 --> 00:00:14,080 Speaker 1: A woman getting off a subway in Boston fell and 2 00:00:14,080 --> 00:00:17,480 Speaker 1: got her leg trapped between the train and the platform. 3 00:00:17,480 --> 00:00:20,200 Speaker 1: The Boston Globe reported that she was injured so badly 4 00:00:20,560 --> 00:00:24,560 Speaker 1: the bone was exposed, yet she begged bystanders not to 5 00:00:24,600 --> 00:00:27,560 Speaker 1: call an ambulance because she worried it would cost too much. 6 00:00:28,120 --> 00:00:30,520 Speaker 1: Last year, Box told the story of a mother who 7 00:00:30,560 --> 00:00:33,520 Speaker 1: parked outside a hospital with her toddler after the child 8 00:00:33,560 --> 00:00:36,879 Speaker 1: swallowed some dramamine pills. She waited in the car for 9 00:00:36,960 --> 00:00:39,960 Speaker 1: hours to see if her daughter would get sick, without 10 00:00:40,040 --> 00:00:43,000 Speaker 1: ever going inside. She said she was afraid of what 11 00:00:43,080 --> 00:00:47,239 Speaker 1: she might be charged for any treatment. American healthcare is 12 00:00:47,280 --> 00:00:50,600 Speaker 1: the most expensive in the world. We're now at the 13 00:00:50,600 --> 00:00:54,080 Speaker 1: point where it's squeezing every aspect of American life, from 14 00:00:54,120 --> 00:00:58,720 Speaker 1: spending by government and employers to individuals. Many people are 15 00:00:58,720 --> 00:01:01,560 Speaker 1: forced to make terrible choice is in their everyday lives 16 00:01:01,600 --> 00:01:04,960 Speaker 1: because they think they can't afford care. How we got 17 00:01:05,000 --> 00:01:07,120 Speaker 1: to this point is the story of a system that 18 00:01:07,200 --> 00:01:14,320 Speaker 1: was allowed to grow out of control. Welcome to Prognosis, 19 00:01:14,400 --> 00:01:17,800 Speaker 1: Bloomberg's podcast about the future of healthcare. I'm your host 20 00:01:17,959 --> 00:01:23,679 Speaker 1: Michelle fay Cortes. Healthcare spending in the United States approached 21 00:01:23,720 --> 00:01:27,759 Speaker 1: four trillion dollars. That's almost one fifth of our economy. 22 00:01:28,560 --> 00:01:31,679 Speaker 1: Yet for all that money, Americans are sicker and they 23 00:01:31,760 --> 00:01:36,679 Speaker 1: die younger than people in other wealthy countries. This season 24 00:01:36,680 --> 00:01:40,240 Speaker 1: on Prognosis, we're exploring the high cost of American healthcare 25 00:01:40,800 --> 00:01:44,960 Speaker 1: and why the system here fails so many people. Over 26 00:01:45,000 --> 00:01:48,640 Speaker 1: the next four episodes, Bloomberg reporter John Tozzi will take 27 00:01:48,720 --> 00:01:51,840 Speaker 1: us through an exploration of how healthcare got so expensive 28 00:01:51,880 --> 00:01:54,960 Speaker 1: in the United States. He'll look at how the steep 29 00:01:54,960 --> 00:01:58,520 Speaker 1: price tag can damage lives and distort our economy, and 30 00:01:58,600 --> 00:02:01,400 Speaker 1: what some people are trying to do about it. Here's 31 00:02:01,480 --> 00:02:13,680 Speaker 1: John with the first episode. About two years ago, Megan 32 00:02:13,800 --> 00:02:17,919 Speaker 1: Nasman caught the flu. Megan is thirty four. She lives 33 00:02:17,960 --> 00:02:21,400 Speaker 1: in Berea, Kentucky with her husband and young son. It 34 00:02:21,440 --> 00:02:24,160 Speaker 1: was her husband who got sick first. He got the 35 00:02:24,200 --> 00:02:27,560 Speaker 1: flu and was was home was really laid up with it. 36 00:02:28,000 --> 00:02:30,920 Speaker 1: A couple of days later, I got the flu as well, 37 00:02:31,320 --> 00:02:34,880 Speaker 1: and the illness quickly turned serious. So that was on 38 00:02:34,919 --> 00:02:38,160 Speaker 1: a Monday when I started feeling bad. On that Wednesday, 39 00:02:38,200 --> 00:02:40,919 Speaker 1: I was actually admitted to the i c U for 40 00:02:41,040 --> 00:02:46,880 Speaker 1: septic shock from the flu and pneumonia, sepsis, and septic 41 00:02:46,919 --> 00:02:50,160 Speaker 1: shock are life threatening conditions caused by your body's response 42 00:02:50,200 --> 00:02:53,680 Speaker 1: to an infection. In septic shock, your blood pressure drops 43 00:02:53,760 --> 00:02:58,200 Speaker 1: dangerously and your organs can fail. Megan's doctors initially thought 44 00:02:58,240 --> 00:03:00,600 Speaker 1: that her septic shock might have been caused by a 45 00:03:00,760 --> 00:03:04,519 Speaker 1: urinary tract infection or U T I. Later I found 46 00:03:04,560 --> 00:03:06,760 Speaker 1: out that wasn't the case, but that the blood in 47 00:03:06,800 --> 00:03:09,760 Speaker 1: my urine was because my kidneys were starting to shut down. 48 00:03:11,200 --> 00:03:16,120 Speaker 1: Septic shock is fatal. About the time Megan was hospitalized 49 00:03:16,160 --> 00:03:19,800 Speaker 1: for almost a week. She went home on a Monday, 50 00:03:19,840 --> 00:03:24,040 Speaker 1: but her health scare wasn't over by Friday night. She 51 00:03:24,120 --> 00:03:26,880 Speaker 1: thought he might be getting sick again. I got up 52 00:03:26,880 --> 00:03:29,040 Speaker 1: in the middle of the night one night to pee 53 00:03:29,600 --> 00:03:34,800 Speaker 1: and my urethra felt irritated. So I was worried, and 54 00:03:34,840 --> 00:03:37,440 Speaker 1: I thought, oh, geez, do I have a U T I, 55 00:03:37,880 --> 00:03:41,240 Speaker 1: which I knew could lead to sepsis again. Megan didn't 56 00:03:41,280 --> 00:03:43,640 Speaker 1: know what to do. She thought about going to the 57 00:03:43,680 --> 00:03:48,400 Speaker 1: emergency room. Her health insurance had covered her earlier hospital stay, 58 00:03:48,440 --> 00:03:50,400 Speaker 1: but she also wanted to make sure that it would 59 00:03:50,480 --> 00:03:54,040 Speaker 1: cover a new visit. Even though Megan has health insurance, 60 00:03:54,200 --> 00:03:56,800 Speaker 1: the cost of medical care is often on her mind. 61 00:03:57,680 --> 00:04:00,800 Speaker 1: She has severe asthma and her medication cost about a 62 00:04:00,800 --> 00:04:04,280 Speaker 1: thousand dollars a month without coverage. When I go and 63 00:04:04,280 --> 00:04:07,720 Speaker 1: I log into my Anthem account and I see the 64 00:04:07,760 --> 00:04:11,400 Speaker 1: price of the claims for the year, I think this year, 65 00:04:11,440 --> 00:04:14,000 Speaker 1: I'm up around twenty seven thou dollars that if I 66 00:04:14,000 --> 00:04:17,520 Speaker 1: didn't have insurance, would be more. There was another reason 67 00:04:17,600 --> 00:04:19,800 Speaker 1: Megan wanted to be sure she would be covered if 68 00:04:19,839 --> 00:04:22,599 Speaker 1: she went back to the hospital. She and her husband 69 00:04:22,640 --> 00:04:25,320 Speaker 1: were saving up to buy a home. We were looking 70 00:04:25,360 --> 00:04:28,000 Speaker 1: to buy a house, so we had been saving up 71 00:04:28,000 --> 00:04:30,440 Speaker 1: for a down payment and we were thinking, like, well, 72 00:04:31,200 --> 00:04:35,839 Speaker 1: one uncovered e er visit could wipe out a significant 73 00:04:35,920 --> 00:04:37,919 Speaker 1: chunk of what we have as a down payment for 74 00:04:38,000 --> 00:04:44,679 Speaker 1: a house. But the pain wasn't going away, so Megan 75 00:04:44,760 --> 00:04:48,160 Speaker 1: called her insurance company. So it's the middle of the night. 76 00:04:48,360 --> 00:04:52,640 Speaker 1: I am bone tired from being in the hospital for 77 00:04:52,680 --> 00:04:55,039 Speaker 1: a week, from having a nine month old I was 78 00:04:55,040 --> 00:04:59,360 Speaker 1: still breastfeeding at the time. UM I called the Anthem 79 00:04:59,560 --> 00:05:03,240 Speaker 1: nurse line on my my card and I say, hey, 80 00:05:03,640 --> 00:05:07,120 Speaker 1: I know that Anthem said it won't cover emergency room 81 00:05:07,240 --> 00:05:12,000 Speaker 1: visits for what they deemed to be not emergencies. I 82 00:05:12,040 --> 00:05:15,640 Speaker 1: asked Anthem, Megan's insurance company, to comment on her story 83 00:05:15,880 --> 00:05:19,880 Speaker 1: with her permission. In their statement, Anthem said that quote 84 00:05:20,360 --> 00:05:24,039 Speaker 1: consumers who reasonably believe that they are experiencing an emergency 85 00:05:24,080 --> 00:05:27,760 Speaker 1: medical condition should always go to the emergency room or call. 86 00:05:29,440 --> 00:05:32,919 Speaker 1: But Megan didn't know if it would be considered an emergency. 87 00:05:33,120 --> 00:05:35,200 Speaker 1: I said, you know, can you just confirm, can you 88 00:05:35,240 --> 00:05:38,960 Speaker 1: just tell me that under these circumstances, I should go 89 00:05:39,040 --> 00:05:42,320 Speaker 1: to the er and it will be covered. And they couldn't. 90 00:05:42,839 --> 00:05:46,800 Speaker 1: They didn't have that authority within the system, so they 91 00:05:46,839 --> 00:05:51,080 Speaker 1: couldn't guarantee that. So here's Megan. She's just out of 92 00:05:51,080 --> 00:05:54,040 Speaker 1: the hospital from an infection that could have killed her. 93 00:05:54,720 --> 00:05:57,040 Speaker 1: She thinks she might be getting sick again with the 94 00:05:57,120 --> 00:06:00,520 Speaker 1: same thing, and instead of going straight to the hospital, 95 00:06:01,000 --> 00:06:04,160 Speaker 1: she calls her health inference company. She wants to know 96 00:06:04,360 --> 00:06:08,640 Speaker 1: whether the hospital trip might wipe out her savings. Instead, 97 00:06:08,720 --> 00:06:11,200 Speaker 1: they said, you know, well, it's it's up to you. 98 00:06:11,400 --> 00:06:16,240 Speaker 1: And I was feeling panicky because you know, I had 99 00:06:16,360 --> 00:06:21,920 Speaker 1: just gone through a near death situation and trying we 100 00:06:21,920 --> 00:06:26,200 Speaker 1: were trying to weigh you know, what do we what 101 00:06:26,240 --> 00:06:28,720 Speaker 1: do we do? What? What can we afford what can 102 00:06:28,760 --> 00:06:32,320 Speaker 1: we not afford? Megan is far from the only person 103 00:06:32,400 --> 00:06:35,440 Speaker 1: who has had to make this kind of decision. Federal 104 00:06:35,480 --> 00:06:39,440 Speaker 1: surveys say that about ten of American adults skip or 105 00:06:39,440 --> 00:06:43,920 Speaker 1: delay healthcare because of the cost. The situation Megan faced 106 00:06:44,040 --> 00:06:47,600 Speaker 1: is a symptom of a much bigger problem in American healthcare. 107 00:06:48,160 --> 00:06:51,880 Speaker 1: It's both really expensive and it often doesn't work very 108 00:06:51,960 --> 00:06:55,560 Speaker 1: well for a lot of people. It doesn't work very 109 00:06:55,600 --> 00:07:01,200 Speaker 1: well because it's so expensive. The health care system in 110 00:07:01,240 --> 00:07:06,200 Speaker 1: the US is just a never ending sequence of impossible problems. 111 00:07:06,560 --> 00:07:09,600 Speaker 1: That's Austin fact. I'm a health economist with the Department 112 00:07:09,600 --> 00:07:12,840 Speaker 1: of Veterans Affairs, Boston University School Public Health, and the 113 00:07:12,880 --> 00:07:16,080 Speaker 1: Harvard th h chn School of Public Health. Austin started 114 00:07:16,080 --> 00:07:19,760 Speaker 1: out studying physics and engineering, but he was eventually drawn 115 00:07:19,880 --> 00:07:23,000 Speaker 1: to health economics. He's interested in health care for the 116 00:07:23,080 --> 00:07:26,760 Speaker 1: same reason most Americans find it so frustrating. It doesn't 117 00:07:26,760 --> 00:07:30,240 Speaker 1: make any sense. I love problems and I love puzzles, 118 00:07:30,760 --> 00:07:35,760 Speaker 1: so I find that motivating and interesting. Austin says, the 119 00:07:35,760 --> 00:07:39,720 Speaker 1: biggest problem in American healthcare is the price tag. I 120 00:07:39,720 --> 00:07:42,120 Speaker 1: think the top line problem is just that it is 121 00:07:42,240 --> 00:07:45,640 Speaker 1: so expensive. I mean, it's so much more expensive than 122 00:07:45,680 --> 00:07:48,000 Speaker 1: anywhere else in the world. It's to the point where 123 00:07:48,800 --> 00:07:52,320 Speaker 1: a family that gets health insurance through their employer that 124 00:07:52,400 --> 00:07:55,880 Speaker 1: costs over tars a year now for a family. That 125 00:07:56,000 --> 00:07:58,800 Speaker 1: counts what workers pay for their insurance premiums and the 126 00:07:58,840 --> 00:08:01,920 Speaker 1: money their employers can tribute, and it doesn't even count 127 00:08:02,000 --> 00:08:06,360 Speaker 1: out of pocket expenses like deductibles or co payments. That's 128 00:08:06,400 --> 00:08:10,200 Speaker 1: like having a family buy a new car every year, 129 00:08:10,240 --> 00:08:12,760 Speaker 1: obviously an economy car, not like a Mercedes, although in 130 00:08:12,800 --> 00:08:14,560 Speaker 1: a few decades maybe they'll be like making them by 131 00:08:14,560 --> 00:08:18,920 Speaker 1: a Mercedes every year. So I think that drives everything 132 00:08:18,920 --> 00:08:21,680 Speaker 1: else about what we're concerned about. When you add up 133 00:08:21,720 --> 00:08:25,600 Speaker 1: all the money that the government, private employers, and families 134 00:08:25,800 --> 00:08:29,600 Speaker 1: spend on healthcare, it will be about four trillion dollars. 135 00:08:31,200 --> 00:08:35,920 Speaker 1: That's about eighteen of America's gross domestic product. It's a 136 00:08:36,040 --> 00:08:39,720 Speaker 1: lot more than in other wealthy democracies, or health spending 137 00:08:39,760 --> 00:08:43,640 Speaker 1: typically makes up about ten of the economy. That includes 138 00:08:43,720 --> 00:08:46,920 Speaker 1: countries with publicly run health care systems like the United 139 00:08:47,000 --> 00:08:51,360 Speaker 1: Kingdom and places with private insurance like the Netherlands. This 140 00:08:51,480 --> 00:08:56,040 Speaker 1: outsized cost of US healthcare affects americans lives in real 141 00:08:56,400 --> 00:09:00,480 Speaker 1: consequential ways. Not long after she finished college, Megan had 142 00:09:00,480 --> 00:09:03,679 Speaker 1: an offer for her dream job, working as a naturalist 143 00:09:03,720 --> 00:09:08,040 Speaker 1: at an outdoor education center. I was super excited about 144 00:09:08,120 --> 00:09:10,960 Speaker 1: the naturalist role. You know, that was what I what 145 00:09:11,040 --> 00:09:12,600 Speaker 1: I thought I wanted to be when I grew up 146 00:09:12,640 --> 00:09:16,280 Speaker 1: sort of thing. But there was one hitch. The company 147 00:09:16,400 --> 00:09:20,040 Speaker 1: had a year long waiting period before new employees could 148 00:09:20,120 --> 00:09:23,880 Speaker 1: join their group health plan. This was before the Affordable 149 00:09:23,920 --> 00:09:27,440 Speaker 1: Care Act, and insurance companies could have denied making coverage 150 00:09:27,559 --> 00:09:31,439 Speaker 1: because her asthma was a pre existing condition. My prescriptions 151 00:09:31,679 --> 00:09:35,520 Speaker 1: were nine a month or so if I didn't get sick. 152 00:09:35,800 --> 00:09:38,200 Speaker 1: She couldn't afford to pay that out of pocket. She 153 00:09:38,320 --> 00:09:42,160 Speaker 1: did briefly consider a more radical way to get health coverage. 154 00:09:42,480 --> 00:09:47,120 Speaker 1: I did have friends somewhat seriously offer, you know, if 155 00:09:47,200 --> 00:09:50,400 Speaker 1: you can't get this workout worked out, we can have 156 00:09:50,640 --> 00:09:53,960 Speaker 1: basically a sham marriage for you to have health insurance 157 00:09:54,000 --> 00:09:58,800 Speaker 1: through my employer. But Megan didn't elope for the health benefits. Instead, 158 00:09:59,000 --> 00:10:01,240 Speaker 1: she took a different po vision that let her hold 159 00:10:01,280 --> 00:10:04,880 Speaker 1: on to coverage. The choice influenced the path of her 160 00:10:04,920 --> 00:10:11,120 Speaker 1: whole career. I didn't have the privilege of good enough health. 161 00:10:11,360 --> 00:10:16,800 Speaker 1: To be able to make my decisions around my passions, 162 00:10:16,880 --> 00:10:21,120 Speaker 1: my education, I had to make a choice based on 163 00:10:22,880 --> 00:10:28,480 Speaker 1: you know what, literally would keep me breathing. Choices like 164 00:10:28,600 --> 00:10:33,040 Speaker 1: this play out all over the country. Employers choose between 165 00:10:33,040 --> 00:10:35,880 Speaker 1: giving workers a raise or paying an increase in their 166 00:10:35,920 --> 00:10:40,720 Speaker 1: health insurance premiums. States choose between funding public colleges and 167 00:10:40,760 --> 00:10:45,640 Speaker 1: building roads or funding state medicaid programs. We're putting more 168 00:10:45,679 --> 00:10:49,280 Speaker 1: and more money into the healthcare system. That leaves less 169 00:10:49,360 --> 00:10:52,760 Speaker 1: money to invest in other things. And for all the 170 00:10:52,840 --> 00:10:56,280 Speaker 1: trillions of dollars that we spend on healthcare each year, 171 00:10:56,720 --> 00:11:01,079 Speaker 1: we're not doing better than other countries that spent less. 172 00:11:01,160 --> 00:11:04,680 Speaker 1: In fact, life expectancy in the United States is lagging 173 00:11:04,720 --> 00:11:08,840 Speaker 1: behind other wealthy democracies. There are a lot of other 174 00:11:08,960 --> 00:11:13,160 Speaker 1: things that affect life expectancy beyond medical care, but economist 175 00:11:13,160 --> 00:11:16,360 Speaker 1: Austin fract says, if we spend money on healthcare in 176 00:11:16,440 --> 00:11:19,960 Speaker 1: order to feel better and live longer, Americans are spending 177 00:11:19,960 --> 00:11:22,520 Speaker 1: more than other countries and we're getting less for it. 178 00:11:22,960 --> 00:11:26,320 Speaker 1: You might ask the question which countries are more efficient, 179 00:11:26,520 --> 00:11:29,240 Speaker 1: as as every country has put more dollars into their 180 00:11:29,280 --> 00:11:31,360 Speaker 1: health care system and they all have over over the 181 00:11:31,480 --> 00:11:35,480 Speaker 1: last forty years, Um, which country is getting more value 182 00:11:36,000 --> 00:11:39,439 Speaker 1: for those dollars? And uh, you know in every country, 183 00:11:39,640 --> 00:11:41,440 Speaker 1: you know, life expecting is going is going up. In 184 00:11:41,480 --> 00:11:44,400 Speaker 1: every country they're spending more. But per dollar, how much 185 00:11:44,480 --> 00:11:47,040 Speaker 1: is life expectancy going up? Uh? And in the US 186 00:11:47,120 --> 00:11:50,160 Speaker 1: it's a lot less than in other countries. And here's 187 00:11:50,200 --> 00:11:54,280 Speaker 1: the thing, it wasn't always this way. As recently as 188 00:11:54,320 --> 00:11:58,920 Speaker 1: the eighties, are health care spending resembled that of other countries, 189 00:11:59,559 --> 00:12:03,520 Speaker 1: and our life expectancy was similar as well. For many 190 00:12:03,600 --> 00:12:07,000 Speaker 1: of us, this problem that we're talking about, the wild 191 00:12:07,080 --> 00:12:11,319 Speaker 1: expense of American healthcare, has grown up in our own lifetimes. 192 00:12:12,240 --> 00:12:15,280 Speaker 1: It's not some law of nature that American healthcare has 193 00:12:15,320 --> 00:12:19,440 Speaker 1: always been more expensive and always will be. Something happened 194 00:12:19,520 --> 00:12:23,160 Speaker 1: that caused the price of our care to skyrocket. Three 195 00:12:23,240 --> 00:12:27,840 Speaker 1: big things make the story different in the United States. First, 196 00:12:28,200 --> 00:12:32,480 Speaker 1: we never set limits on what we'd pay for new treatments. Second, 197 00:12:32,760 --> 00:12:37,280 Speaker 1: the health care system became a lot more complicated, and third, 198 00:12:37,720 --> 00:12:48,840 Speaker 1: the health care industry became much more consolidated. First, let's 199 00:12:48,880 --> 00:12:52,640 Speaker 1: talk about new treatments. Our technology has become so much 200 00:12:52,640 --> 00:12:57,240 Speaker 1: more sophisticated since the new scanners like m r s 201 00:12:57,320 --> 00:13:01,120 Speaker 1: let doctors look inside the body. Extraordinary medical procedures like 202 00:13:01,240 --> 00:13:04,840 Speaker 1: organ transplants became more common, and new drugs hit the market. 203 00:13:05,120 --> 00:13:08,680 Speaker 1: We've had this explosion of new technology, new treatment's, new 204 00:13:08,720 --> 00:13:12,720 Speaker 1: diagnostic tests a FIFA as a physician and professor at Harvard, 205 00:13:12,880 --> 00:13:15,360 Speaker 1: these are good things, right, They've made people healthier and 206 00:13:15,440 --> 00:13:18,160 Speaker 1: live longer and live better. But all that comes at 207 00:13:18,200 --> 00:13:21,840 Speaker 1: a price. After all, investors took some risk to develop 208 00:13:21,880 --> 00:13:25,400 Speaker 1: new treatments. Businesses don't bring new products to market if 209 00:13:25,440 --> 00:13:28,000 Speaker 1: they don't expect to make a profit, and America has 210 00:13:28,080 --> 00:13:31,040 Speaker 1: just been willing to pay much higher prices than the 211 00:13:31,040 --> 00:13:34,360 Speaker 1: rest of the world. Other countries responded by putting in 212 00:13:34,440 --> 00:13:36,720 Speaker 1: breaks into the system. They put in a whole bunch 213 00:13:36,720 --> 00:13:40,440 Speaker 1: of things to kind of control that spending. The United 214 00:13:40,520 --> 00:13:43,720 Speaker 1: Kingdom created a group twenty years ago to evaluate new 215 00:13:43,760 --> 00:13:47,560 Speaker 1: health technologies and decide whether they're worth the cost. But 216 00:13:47,640 --> 00:13:50,160 Speaker 1: as other countries put some limits on what they would 217 00:13:50,160 --> 00:13:54,760 Speaker 1: spend on healthcare, the United States just didn't. That allowed 218 00:13:54,800 --> 00:13:58,640 Speaker 1: medical costs to rise faster as we paid more and 219 00:13:58,679 --> 00:14:07,160 Speaker 1: more for each scan, hill or procedure. The second reason 220 00:14:07,160 --> 00:14:10,320 Speaker 1: that healthcare got so expensive in America is that the 221 00:14:10,440 --> 00:14:15,319 Speaker 1: system became a lot more complicated. Insurance companies made patients, 222 00:14:15,679 --> 00:14:19,160 Speaker 1: doctors and hospitals jumped through more hoops to prove that 223 00:14:19,240 --> 00:14:23,840 Speaker 1: treatments are necessary. Here's Austin behind the scenes. Mostly to 224 00:14:23,960 --> 00:14:27,280 Speaker 1: us is a huge army of people who are managing 225 00:14:27,960 --> 00:14:31,240 Speaker 1: how the hospital and doctors are going to get paid 226 00:14:31,280 --> 00:14:35,560 Speaker 1: for those services. And that's extremely complicated because exactly how 227 00:14:35,600 --> 00:14:40,320 Speaker 1: they get paid, uh, depends on our particular insurance, and 228 00:14:40,360 --> 00:14:43,840 Speaker 1: my insurance is different from your insurance. And finally, the 229 00:14:43,920 --> 00:14:49,440 Speaker 1: health care industry also became more consolidated. Insurance companies merged 230 00:14:49,480 --> 00:14:54,000 Speaker 1: into bigger insurance companies. Hospitals joined together to form big 231 00:14:54,040 --> 00:14:58,040 Speaker 1: health care systems that dominated local markets. They can command 232 00:14:58,120 --> 00:15:00,360 Speaker 1: more market power, they can command higher prices. That's going 233 00:15:00,400 --> 00:15:04,240 Speaker 1: to drive your premiums up. Bigger healthcare entities are also 234 00:15:04,320 --> 00:15:09,000 Speaker 1: more politically powerful. They can influence government policies that affect 235 00:15:09,000 --> 00:15:13,960 Speaker 1: how much we pay for healthcare. Then, Medicare is a 236 00:15:14,000 --> 00:15:17,200 Speaker 1: government plan. It sets prices, there's no negotiation involved, it 237 00:15:17,240 --> 00:15:20,880 Speaker 1: just sets them. But it is subject to the political process. 238 00:15:20,960 --> 00:15:24,520 Speaker 1: And healthcare is now so big again almost one fifth 239 00:15:24,520 --> 00:15:27,800 Speaker 1: of our economy, that it is also a major political 240 00:15:27,800 --> 00:15:31,960 Speaker 1: player and healthcare organizations, hospitals, physician groups. They have a 241 00:15:31,960 --> 00:15:36,560 Speaker 1: lot of political clout and uh they're able to influence 242 00:15:36,600 --> 00:15:39,760 Speaker 1: how prices are set through public programs to keep them 243 00:15:39,800 --> 00:15:44,880 Speaker 1: higher than they would otherwise be. So in America, we 244 00:15:44,960 --> 00:15:48,880 Speaker 1: didn't really limit what we would pay for new medical technologies. 245 00:15:49,640 --> 00:15:53,000 Speaker 1: We watched as our system grow more and more complex, 246 00:15:53,360 --> 00:15:58,000 Speaker 1: and healthcare organizations got bigger and more powerful, and year 247 00:15:58,040 --> 00:16:01,680 Speaker 1: by year, the small difference is between what Americans spend 248 00:16:01,720 --> 00:16:05,360 Speaker 1: on healthcare and what other countries spend became big ones. 249 00:16:06,280 --> 00:16:09,440 Speaker 1: The result is the most expensive healthcare in the world. 250 00:16:14,920 --> 00:16:18,800 Speaker 1: Researcher Ashish jah says healthcare in the US is even 251 00:16:18,840 --> 00:16:23,320 Speaker 1: more costly than pricing countries like Switzerland. Everything there is 252 00:16:23,520 --> 00:16:27,680 Speaker 1: so much more expensive than most American cities except one thing. 253 00:16:28,240 --> 00:16:30,840 Speaker 1: You know, if you need an m R I in Geneva, 254 00:16:31,280 --> 00:16:33,240 Speaker 1: you're gonna end up spending probably half of what you 255 00:16:33,240 --> 00:16:37,520 Speaker 1: would spend in Topeka, Kansas, or in Boston. It's really 256 00:16:37,600 --> 00:16:40,840 Speaker 1: about the craziness of the pricing in the US, much 257 00:16:40,880 --> 00:16:43,720 Speaker 1: more than it is that somehow the Swiss I've figured 258 00:16:43,720 --> 00:16:45,920 Speaker 1: out how to do m r s cheaper. The fact 259 00:16:46,040 --> 00:16:49,200 Speaker 1: that we spend so much more than everywhere else has 260 00:16:49,360 --> 00:16:53,840 Speaker 1: huge consequences for our economy, our government, and for each 261 00:16:53,840 --> 00:16:57,960 Speaker 1: of us. People and organizations are constantly forced to make 262 00:16:58,000 --> 00:17:01,240 Speaker 1: the kind of choices that Megan has had to pay 263 00:17:01,320 --> 00:17:05,160 Speaker 1: for healthcare or pay for something else. Megan was grappling 264 00:17:05,200 --> 00:17:09,280 Speaker 1: with this choice on that night in February. She feared 265 00:17:09,320 --> 00:17:12,600 Speaker 1: she might be sliding back into a life threatening illness. 266 00:17:13,080 --> 00:17:15,800 Speaker 1: The call with a nurse from her insurance company didn't 267 00:17:15,800 --> 00:17:19,000 Speaker 1: make her feel any better. After I had talked to 268 00:17:19,119 --> 00:17:23,680 Speaker 1: the nurse, my husband and I were basically deciding, Okay, 269 00:17:23,760 --> 00:17:27,520 Speaker 1: we've been saving for years, since before we even knew 270 00:17:27,560 --> 00:17:30,640 Speaker 1: each other, for a down payment for a house. So 271 00:17:30,680 --> 00:17:33,840 Speaker 1: we have this little nest egg. Should you go to 272 00:17:33,880 --> 00:17:39,600 Speaker 1: the emergency room and we maybe lose that that that 273 00:17:39,880 --> 00:17:43,520 Speaker 1: sense of security we've been working for if somebody at 274 00:17:43,520 --> 00:17:47,080 Speaker 1: Anthem says that wasn't an emergency. The nurse told Megan 275 00:17:47,280 --> 00:17:50,679 Speaker 1: that her temperature would rise if she was becoming septic again, 276 00:17:51,480 --> 00:17:54,159 Speaker 1: so she and her husband decided that they check her 277 00:17:54,160 --> 00:17:58,159 Speaker 1: temperature every half hour. If it started to go up, 278 00:17:58,600 --> 00:18:02,760 Speaker 1: they'd go to the emergency room. So instead of sleeping, 279 00:18:03,400 --> 00:18:06,280 Speaker 1: like you might think would be great for somebody who 280 00:18:06,320 --> 00:18:08,360 Speaker 1: just got out of the hospital, has been through this 281 00:18:09,160 --> 00:18:15,080 Speaker 1: tremendously traumatic situation. I was staying up, I had a 282 00:18:15,080 --> 00:18:17,480 Speaker 1: little time around my phone and I would just sit 283 00:18:17,600 --> 00:18:22,320 Speaker 1: an alarm um and I just kept monitoring my temperature 284 00:18:23,119 --> 00:18:26,080 Speaker 1: um instead of going into the emergency room to just 285 00:18:26,160 --> 00:18:30,480 Speaker 1: have a simple ten minute U t I test because 286 00:18:30,520 --> 00:18:33,120 Speaker 1: I didn't know if it would cost us the ability 287 00:18:33,160 --> 00:18:41,600 Speaker 1: to buy a house. Megan's temperature didn't rise, and she 288 00:18:41,720 --> 00:18:44,959 Speaker 1: didn't go to the emergency room. In the morning, as 289 00:18:45,040 --> 00:18:47,479 Speaker 1: soon as it opened, she went to a retail clinic 290 00:18:47,560 --> 00:18:51,080 Speaker 1: at a Kroger supermarket nearby. She got a lab test 291 00:18:51,240 --> 00:18:53,480 Speaker 1: that was much less expensive than it would have been 292 00:18:53,600 --> 00:18:57,960 Speaker 1: at the hospital. She didn't have a new infection. The 293 00:18:58,040 --> 00:19:00,480 Speaker 1: pain she was feeling was a side effect of other 294 00:19:00,560 --> 00:19:04,000 Speaker 1: medicines she had been taking. In a statement of Bloomberg News, 295 00:19:04,280 --> 00:19:07,320 Speaker 1: Anthem said that when Megan called the nurse line quote, 296 00:19:07,760 --> 00:19:10,520 Speaker 1: she was provided the recommendation to be seen by a 297 00:19:10,600 --> 00:19:12,919 Speaker 1: doctor that evening or at the latest in the morning. 298 00:19:13,560 --> 00:19:16,959 Speaker 1: Further recommendations included the option to have a consult with 299 00:19:17,000 --> 00:19:21,680 Speaker 1: a physician end quote through Anthems seven telet Health Service. 300 00:19:22,640 --> 00:19:25,600 Speaker 1: Anthem also said that the nurse line doesn't have access 301 00:19:25,600 --> 00:19:29,000 Speaker 1: to members plan or coverage details, so Megan was instructed 302 00:19:29,040 --> 00:19:33,359 Speaker 1: to call customer service. If you just look at this 303 00:19:33,440 --> 00:19:37,880 Speaker 1: on paper, Megan's story might be considered a success. Emergency 304 00:19:37,960 --> 00:19:41,240 Speaker 1: rooms are some of the most intensive and costly resources 305 00:19:41,240 --> 00:19:44,600 Speaker 1: in the health care system, and insurers try to reduce 306 00:19:44,680 --> 00:19:48,160 Speaker 1: costs by keeping people out of hospitals when they don't 307 00:19:48,200 --> 00:19:50,480 Speaker 1: need to be there. If Megan had gone to the 308 00:19:50,520 --> 00:19:53,520 Speaker 1: e R, it could have cost her insurance company or 309 00:19:53,560 --> 00:19:57,240 Speaker 1: her family thousands of dollars more than waiting until the morning. 310 00:19:57,800 --> 00:20:00,680 Speaker 1: But that's on paper, and if you talk to Megan, 311 00:20:01,080 --> 00:20:04,000 Speaker 1: it's clear that she does not feel like this was 312 00:20:04,080 --> 00:20:08,600 Speaker 1: a good outcome. She says she feels traumatized by the experience. 313 00:20:09,280 --> 00:20:12,040 Speaker 1: I know that hospital bills can be way out of 314 00:20:12,080 --> 00:20:14,880 Speaker 1: line with what you think feels reasonable and what does 315 00:20:14,960 --> 00:20:19,000 Speaker 1: feel reasonable. Um, so we didn't feel like we could 316 00:20:19,000 --> 00:20:25,399 Speaker 1: afford um to take that risk, which is atrocious. You know, 317 00:20:25,440 --> 00:20:34,080 Speaker 1: I had just almost died. Megan and her husband are 318 00:20:34,160 --> 00:20:38,359 Speaker 1: middle class, educated professionals. They're not poor, and they have 319 00:20:38,480 --> 00:20:41,960 Speaker 1: health insurance. Yet they're among the millions of Americans whose 320 00:20:42,000 --> 00:20:44,640 Speaker 1: lives are shaped by the high cost of healthcare. Every 321 00:20:44,720 --> 00:20:49,240 Speaker 1: day this four killion dollar problem is only getting more serious. 322 00:20:50,000 --> 00:20:53,679 Speaker 1: For years, experts and politicians have called this level of 323 00:20:53,720 --> 00:20:59,040 Speaker 1: healthcare spending unsustainable, but each year the price tag goes up. 324 00:20:59,640 --> 00:21:03,080 Speaker 1: It is is faster than inflation and faster than wages, 325 00:21:03,520 --> 00:21:06,560 Speaker 1: and as the cost of healthcare rises, we have less 326 00:21:06,640 --> 00:21:09,960 Speaker 1: and less to invest in all the other things we 327 00:21:10,000 --> 00:21:49,600 Speaker 1: want and need. That's it for this week's prognosis. In 328 00:21:49,680 --> 00:21:52,359 Speaker 1: coming weeks, we'll visit some novel approaches to solving the 329 00:21:52,400 --> 00:21:56,199 Speaker 1: healthcare cost puzzle. Do you have a story about healthcare 330 00:21:56,240 --> 00:21:58,359 Speaker 1: in the US or around the world. We want to 331 00:21:58,400 --> 00:22:01,480 Speaker 1: hear from you. Find us on Twitter at fay Cortes 332 00:22:01,720 --> 00:22:04,960 Speaker 1: or at Jaytaws. If you were a fan of this episode, 333 00:22:05,240 --> 00:22:07,880 Speaker 1: please take a minute to rate and review us. It 334 00:22:07,960 --> 00:22:11,040 Speaker 1: really helps new listeners find the show and don't forget 335 00:22:11,080 --> 00:22:15,359 Speaker 1: to subscribe. This episode was produced and edited by Top 336 00:22:15,480 --> 00:22:19,080 Speaker 1: Foreheads and Rick Shine. Special thanks to help team leader 337 00:22:19,200 --> 00:22:23,680 Speaker 1: Drew Armstrong. Francesca Leavie is head of Bloomberg Podcasts. Thanks 338 00:22:23,680 --> 00:22:24,199 Speaker 1: for listening.