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Speaker 1: The Michael Berry Show, as some of you know, because

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Speaker 1: I talk about my personal life on the air. It's

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Speaker 1: all I got to talk about, and I share how

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Speaker 1: I interact with the policies and politics that we talk about,

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Speaker 1: because at the end of the day, these aren't academic discussions. Right.

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Speaker 1: If the government takes over our health care, that's going

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Speaker 1: to affect you. And just because you're young and healthy

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Speaker 1: and haven't needed health care yet or recently, you don't

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Speaker 1: realize that, and you see it as some sort of

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Speaker 1: arcane or ethereal existential discussion. But that's not where it

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Speaker 1: is for me. I have a brother who died of

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Speaker 1: the clot shot, a perfectly able bodied law enforcement officer

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Speaker 1: with over thirty years who died of the clot shot

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Speaker 1: January twenty fifth, twenty twenty two. My father is eighty four,

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Speaker 1: and since he was twenty years old and had to

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Speaker 1: be discharged from the Coast Guard on his deathbed with

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Speaker 1: a severe case of diabetes, and they didn't know how

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Speaker 1: to treat it back then, they sent him home to die,

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Speaker 1: and he read and experimented, and here we are, he's

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Speaker 1: eighty four and still alive, still battling diabetes. By the day.

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Speaker 2: He is.

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Speaker 1: In constant contact with doctors, and many of them have

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Speaker 1: told me, your dad knows more about diabetes than diabetes

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Speaker 1: doctors do, because in an era before we had proper insulin,

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Speaker 1: he was managing his blood sugar that's unheard of. And

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Speaker 1: he still has his vision in all ten of his

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Speaker 1: fingers and toes well. He's a man of great self

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Speaker 1: discipline and the willingness to experiment on himself and get

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Speaker 1: enough sleep and not drink and you know, do the

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Speaker 1: things that are necessary. And then, of course my mother,

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Speaker 1: five years younger than him. My father was supposed to

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Speaker 1: go first, and my mother would nurse him until the end.

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Speaker 2: Of his life.

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Speaker 1: And she up and passes on us. And she ended

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Speaker 1: up having als that basically just eventually took over her

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Speaker 1: body and left her unable to breathe. Her lungs just

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Speaker 1: wouldn't function, and it was a horrible, horrible way to go.

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Speaker 1: She died in hospice at our home. I have been

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Speaker 1: in and out of hospitals just with these things so

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Speaker 1: many times over the last few years that I have

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Speaker 1: come to learn a lot about the medical care system.

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Speaker 2: You know.

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Speaker 1: I had a minor stroke on August first, twenty sixteen.

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Speaker 1: I you know, we've all had our medical issues. I'm

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Speaker 1: much better now about taking care of my health and

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Speaker 1: getting my checkups and all that. But the policy issue

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Speaker 1: of how we deliver healthcare in a marketplace of people

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Speaker 1: trying to heal you and provide wellness and prevent all

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Speaker 1: these things, it's gotten. It's all messed up, and I

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Speaker 1: don't I think people really even understand why it's all

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Speaker 1: messed up. And so today I would like to step

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Speaker 1: back from the news of the day and address this.

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Speaker 1: There is a fellow who has been highly recommended when

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Speaker 1: I bring these questions up, named Charles Silver. He is

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Speaker 1: the McDonald Endowed Chair of Civil Procedure at the University

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Speaker 1: of Texas at Austin School of Law. I don't know

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Speaker 1: if he was there when I was there in the

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Speaker 1: mid nineties. I don't know him, but his work has

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Speaker 1: been widely widely discussed, particularly his book Overcharged, Why Americans

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Speaker 1: pay too much for healthcare. Professor Silver, welcome to the program.

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Speaker 2: Thank you, Michael, pleasure to be here.

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Speaker 1: I must first ask you if you were on faculty

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Speaker 1: from ninety three to ninety six when I was there.

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Speaker 2: I was I started teaching at Texas in nineteen eighty seven.

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Speaker 1: Oh well, okay, Well, I was a Lino Graula acolyte

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Speaker 1: and I was the first crop. There were two of

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Speaker 1: us that were sent to England to get an LLM degree.

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Speaker 1: So I was kind of checked out after my second year.

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Speaker 1: Once I had my offer, I was kind of checked out.

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Speaker 1: But I'm sorry that I never met you. I had

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Speaker 1: a wonderful experience at the University of Texas School of Law.

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Speaker 1: It's a great university law school, and I am the

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Speaker 1: better for it. So I think a lot of you

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Speaker 1: for being on facutory there. It's a great institution.

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Speaker 2: Let's thank you. I'm sorry I didn't get to meet

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Speaker 2: you when you were a student.

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Speaker 1: Indeed, the book overcharged why Americans pay too much for healthcare?

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Speaker 1: If somebody says, Michael, I'm going to come back and

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Speaker 1: listen on the podcast later, but give me the one

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Speaker 1: minute answer, and then let's get granular and dig into this.

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Speaker 1: What's the one minute answer as to why we pay

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Speaker 1: too much for healthcare?

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Speaker 2: The one minute answer We rely far too heavily on

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Speaker 2: third party payment arrangements, which means insurance companies, Medicare, Medicaid, Trycare, Va,

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Speaker 2: whatever they happen to be instead of paying for health

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Speaker 2: care directly the same way we pay for pretty much

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Speaker 2: everything else food, cars, housing, We pay for the vast

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Speaker 2: majority of things directly, meaning we pay for them ourselves,

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Speaker 2: and we don't have the problem of excessive spending or

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Speaker 2: inflation or costs, or hidden bills or surprise bills or

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Speaker 2: phony charges. All that works really well. The one exception

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Speaker 2: is the healthcare sector, where we rely very very extensively

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Speaker 2: on third parties to pay for things, and that just

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Speaker 2: screws everything up. Now. The other thing is we have

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Speaker 2: way too much governmental involvement in the healthcare sector. There

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Speaker 2: are lots and lots of regulations that make things worse

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Speaker 2: for consumers. By and large, the regulations have the purpose

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Speaker 2: of protecting the producers, not the consumers, so we should

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Speaker 2: do a lot less in that way.

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Speaker 1: You did that. You were technically finished at fifty eight seconds.

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Speaker 1: You added an addendum to the end that I will

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Speaker 1: admit I will it is admissible in this case. But

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Speaker 1: you achieved the fifty eight seconds. I'm quite impressed that

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Speaker 1: you did that. So let's start drilling down on these things.

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Speaker 1: I've got a minute left in this segment, but I

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Speaker 1: have dedicated some time to talk about this because I

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Speaker 1: think a lot of people are frustrated, especially when they

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Speaker 1: start getting all these bills and they go to the

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Speaker 1: emergency room and the place is packed, and then they

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Speaker 1: can't get in to see a doctor, and then they wonder,

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Speaker 1: you know, why does something cost ten thousand dollars that

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Speaker 1: took twenty minutes. It just there's nothing else that requires this.

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Speaker 1: It all seems so frustrating to people, and I would

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Speaker 1: like to drill down and get into the actual reasons

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Speaker 1: why this works. Let me let me start by prefacing,

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Speaker 1: and we'll get to this in the next segment, because

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Speaker 1: I don't want to have to cut you off. I

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Speaker 1: want to first talk about what if we were to

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Speaker 1: do a zero based budget, we were to go back

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Speaker 1: to John Locke's state of nature, and let's start all

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Speaker 1: over and have a cash only health delivery system. Let's

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Speaker 1: do away with insurance, and let's talk about who the

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Speaker 1: winners and losers out of that would be. And more importantly,

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Speaker 1: if I'm if I'm a consumer of health services, because

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Speaker 1: I don't believe that healthcare is a right. If I'm

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Speaker 1: a consumer of health services, would this be better or

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Speaker 1: worse for me, so hang tight right there. Our guest

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Speaker 1: is Professor Charles Silver. I encourage you to read the

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Speaker 1: book Overcharged, Why Americans Pay too Much for Healthcare?

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Speaker 2: Coming up?

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Speaker 3: This is the Michael Berry Show, Locked and Loaded, Loaded.

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Speaker 1: Professor Charles Silver is our guest, and as promised at

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Speaker 1: the end, I given him a moment to consider. Professor,

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Speaker 1: what if we go back the book is Overcharged Why

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Speaker 1: Americans pay too much for healthcare? What if we did

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Speaker 1: away with all insurance and we went cash only? How

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Speaker 1: would that change things?

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Speaker 2: It would change a lot of things for the better,

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Speaker 2: but some things for the worse. So a lot of

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Speaker 2: things would be better. You know. We wouldn't have to

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Speaker 2: worry about things like surprise medical bills where you don't

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Speaker 2: even know what something is going to cost when you

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Speaker 2: get the service delivered. There's actually a very large retail

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Speaker 2: health sector. So if you want to get laser eye surgery,

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Speaker 2: for example, you have to pay for that yourself because

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Speaker 2: it's not covered by insurance typically. But you know what,

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Speaker 2: it's actually very affordable and the price for laser surgery.

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Speaker 2: Are you ready for this? The price has substantially declined

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Speaker 2: since lasik was developed, and it's gotten much better too.

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Speaker 2: There are new forms of LASIK and all that has

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Speaker 2: happened because there is no overlay of insurance. Where where

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Speaker 2: in the healthcare sector except in the private payment sector

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Speaker 2: can one find prices that have declined. Now. There are

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Speaker 2: no hospital services that I'm aware of that cost less

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Speaker 2: now than they used to. But in the private sector

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Speaker 2: where we purchase cosmetic surgery, I mentioned LASC. There's also

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Speaker 2: the Surgery Center of Oklahoma, which takes operates on a

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Speaker 2: cash basis. But there are lots of services that people

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Speaker 2: can buy directly, and those things that part of the

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Speaker 2: market works incredibly well with. As I said, we don't

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Speaker 2: have surprise bills. Everybody knows that they're going to pay

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Speaker 2: before the service is delivered, and nobody gets billed for

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Speaker 2: more than the price. The prices are posted. We don't

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Speaker 2: have to have a you know, in the hospital sector,

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Speaker 2: we have this federal Transparenity rule transparency rule that hospitals

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Speaker 2: routinely ignore that's supposed to require them to post their prices.

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Speaker 2: But in the retail sector, we don't have that, and

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Speaker 2: everybody posts their prices anyway. So a lot of things

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Speaker 2: would work better if we did that. But the one

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Speaker 2: thing that would work. Worse would be emergencies where you're

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Speaker 2: facing a risk of a catastrophic cost that you know

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Speaker 2: people just can't afford to bear on their own. That's

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Speaker 2: where insurance has a role to play. Catastrophic costs.

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Speaker 1: Yeah, professor, I have long advocated that we should if

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Speaker 1: people would understand. For instance, I only have liability insurance

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Speaker 1: on my vehicles, and people say you have to No, no, no,

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Speaker 1: I pay cash for my vehicles. The only reason people

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Speaker 1: are over insured in most cases is because the person

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Speaker 1: holding the loan wants you to have insurance for more

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Speaker 1: than the value of what they're of what they've loaned

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Speaker 1: you money for in case the thing gets burned down

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Speaker 1: or trash, they want their money once. You don't have

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Speaker 1: to do that. In my opinion, I'm a safe driver.

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Speaker 1: I've never met an insurance claim. In my opinion, it's

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Speaker 1: a bad business deal. So what I tell people to

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Speaker 1: do is get catastrophic health insurance so when it hits

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Speaker 1: fifteen thousand and up, it's good. And then pay cash.

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Speaker 1: And you'll be shocked how many doctors will discount what

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Speaker 1: you get and they're happy to have the cash. I

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Speaker 1: go to a doctor, doctor named Mary Tally Boden for

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Speaker 1: all my upper respiratory stuff. And she's a cash only doctor, which,

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Speaker 1: as you know, a lot of people are going to

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Speaker 1: and you go in and you make your payment and

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Speaker 1: it's insanely cheap, and then there's no documentation. Later there's

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Speaker 1: no you know, insurance letter arrives. Do we pay this? No,

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Speaker 1: we wait to pay this. She's happier. She doesn't have

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Speaker 1: to have a bunch of billing clerks. You literally pay

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Speaker 1: the same way if you bought yogurt there. I think

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Speaker 1: this is the answer, Professor.

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Speaker 2: Well, I agree with you because I go to a

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Speaker 2: doctor who works on the same basis. So my doctor

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Speaker 2: I pay a monthly subscription fee too, but I can

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Speaker 2: go as many times as I want. You know, I

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Speaker 2: don't need to go all the time, fortunately, but if

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Speaker 2: I need to go, she usually can see me either

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Speaker 2: that day or the next day, and I get some

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Speaker 2: tests performed in house at no charge. And it's a

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Speaker 2: great working arrangement. Like you, I don't get it. I

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Speaker 2: don't worry about my insurance company, you know, not paying

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Speaker 2: for something. So I think I agree with you. The

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Speaker 2: cash payment is a very good approach for basic healthcare.

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Speaker 1: So let's have a little history lesson. Professor Charles Silver

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Speaker 1: is our guest. The book is called Overcharged, Why Americans

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Speaker 1: paid too much for healthcare. Let's go back to wherever

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Speaker 1: the starting point is you want it to be, nineteen

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Speaker 1: fifty or nineteen seventy. Where did it start going wrong?

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Speaker 1: Because we all know it's wrong.

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Speaker 2: Now.

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Speaker 1: Where did it start going wrong?

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Speaker 2: Oh, that's easy. It started going wrong in the mid

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Speaker 2: nineteen sixties when Medicare and Medicaid came online. In my book,

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Speaker 2: I show how doctors and hospitals fees changed after Medicare

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Speaker 2: and Medicaid took effect in nineteen sixty five, and basically,

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Speaker 2: both of those statutes initially let doctors and hospitals charged

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Speaker 2: whatever they wanted for services, and so, not surprisingly, they

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Speaker 2: started raising their rates immediately, I mean really immediately after

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Speaker 2: the enactment of those programs, we were beset with health

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Speaker 2: care inflation that exceeded the real growth rate of the GDP,

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Speaker 2: and we have been struggling with healthcare inflation ever since.

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Speaker 2: But everything about the arrangement is wrong. I mean, who

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Speaker 2: in their right minds, let's people who are selling things

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Speaker 2: set their own prices without any market constraints. I mean,

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Speaker 2: that's a recipe for disaster, right. And then, of course

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Speaker 2: that couldn't last forever. So the government eventually did get

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Speaker 2: into the price setting business in Medicare and medicaid. But

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Speaker 2: of course we all know that government price setting is terrible.

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Speaker 2: It never works properly. It's really hard to set good prices,

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Speaker 2: to set prices accurately. And moreover, the government really doesn't

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Speaker 2: have the right set of interests. You know, I want

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Speaker 2: just the price that matters to me. It's the convenience, right.

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Speaker 2: How long do I have to wait to see my doctor?

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Speaker 2: How friendly is my doctor, How good is my doctor?

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Speaker 2: There are all these things. Different doctors should have different prices,

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Speaker 2: and markets can work all that stuff out, but governments

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Speaker 2: just are notoriously unable to do that. And so as

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Speaker 2: a result, we've had this terrible system. And because it's

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Speaker 2: so terrible, it's constantly in need of patching. I mean,

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Speaker 2: every time I turn around, there's a new bill, a

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Speaker 2: new proposal being put on the table for some kind

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Speaker 2: of regulation to fix a problem that only exists because

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Speaker 2: the government created it. It's never going to be fixed.

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Speaker 2: It's impossible to fix it. We really need to just

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Speaker 2: scrap these arrangements and go back to a simple cash

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Speaker 2: based system for fundamental care, and then things will start.

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Speaker 2: It will immediately be out of the spending crisis. The

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Speaker 2: prices will moderate because hospitals and doctors and drug companies

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Speaker 2: and all that will have to deal with the realities

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Speaker 2: of the limited budgets of consumers. They'll also have to

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Speaker 2: face competition. That's hugely important. You know, one I mentioned

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Speaker 2: the retail health sector. You know, one of the reasons

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Speaker 2: lasik is cheap is because there are a lot of

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Speaker 2: laser providers and any ophthalmologists can enter the field who

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Speaker 2: wants to. So there's a lot of competition, and competition

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Speaker 2: is good for consumers. So we need to get rid

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Speaker 2: of these competition frustrating regulations. Let's increase the supply. Let

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Speaker 2: you know, foreign doctors who can pass American exams come

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Speaker 2: in and treat people. We need to just open the

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Speaker 2: floodgates for providers because we have this artificially created shortage.

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Speaker 2: You know, that's one of the waves that doctors and

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Speaker 2: hospitals have increased their revenues. It's by preventing new entrants

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Speaker 2: from coming in and you know, outcompete. So we have

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Speaker 2: to get rid of all that.

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Speaker 1: Professor Charles Silver at the University of Texas School of Law,

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Speaker 1: my alma mater, is our guest. His book is Overcharged,

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Speaker 1: Why Americans pay to dang much for healthcare? I added

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Speaker 1: the dang, but I think we all feel it more

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Speaker 1: with Professor Silver coming up to Professor Charles Silver is

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Speaker 1: our guest. He's a professor at the University of Texas

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Speaker 1: School of Law, which I happened to believe is fantastic

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Speaker 1: because I'm a graduate of same. His book is Overcharged,

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Speaker 1: Why Americans Pay too Much for Healthcare? You mentioned that

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Speaker 1: the problem began with Medicare Medicaid in the sixties, part

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Speaker 1: of Lyndon Johnson's Great Society, which turned out not to be.

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Speaker 1: It was two point zero of FDRs taking over of

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Speaker 1: the American economy, and it's hard to strip that back

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Speaker 1: out of life when Medicare got involved. So, my dad's

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

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

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Speaker 1: that this whole Medicare thing. I have a show sponsor

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Speaker 1: called Senior Health Services dot Com, and he and his

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Speaker 1: team help people who are trying to navigate Medicare, and

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Speaker 1: every day I get someone who emails me and says,

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Speaker 1: can you connect me with them? And I forward it,

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Speaker 1: and sometimes I stay involved for a little while just

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Speaker 1: to see, you know, kind of what they're working through.

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Speaker 1: It's amazing to people that all of a sudden, I guess,

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

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Speaker 1: mail and all this Medicare, 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 2: Too well? I just I recently hit that age myself,

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Speaker 2: so I can sympathize with those whose mailboxerre with Medicare

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Speaker 2: advantage flyers and things of that sort. I'm sick of

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Speaker 2: seeing them, and I'm not even using Medicare. I'm still working,

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Speaker 2: so I'm staying on my employer's healthcare system or healthcare insurance,

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Speaker 2: although that is very expensive and far too comprehensive. You know,

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Speaker 2: it's because of the mandates regarding what employer sponsored coverage

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Speaker 2: has to include that I wind up paying, you know,

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Speaker 2: way too much. Everybody does pay way too much for insurance.

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Speaker 2: But you know, Medicare, what can I say? It's a

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Speaker 2: program that was designed to succeed by massively inflating the deficit.

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Speaker 2: You know, everybody thinks that Medicare is something that you

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Speaker 2: earn over the course of your lifetime. We don't think

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Speaker 2: of it as welfare, and politicians who refer to it

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Speaker 2: as welfare are excoriated. But the amount that people pay

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Speaker 2: into Medicare is way, way, way smaller than the amount

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Speaker 2: that they get out for most people. They're obviously exceptions

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Speaker 2: to that, but for most people, the way that the

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Speaker 2: program succeeds is by charging them less than the benefits

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Speaker 2: that they will get out of the system. Well, you know,

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Speaker 2: that's a nice arrangement. I'd like to have that, But

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Speaker 2: the problem is somebody. The money to pay for all

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Speaker 2: those benefits has to come from somewhere, and in only

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Speaker 2: only two sources. One is general tax revenue, so they

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Speaker 2: use money in addition tax revenue in addition to the

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Speaker 2: employee tax to fund the program. And the other is

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Speaker 2: deficit spending. And every one of these expansions of the

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Speaker 2: Medicare program is funded through the deficit. So you know,

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Speaker 2: back when Bush two was president, right, he created Medicare

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Speaker 2: part D, the prescription Drug Benefit Program. Well, the premiums

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Speaker 2: even initially for that program were only set at fifty

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Speaker 2: percent of the estimated cost. Now they're down to twenty

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Speaker 2: five percent of the estimated cost, which means everybody loves

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Speaker 2: Medicare party because it's a great deal. Right, I'm only

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Speaker 2: paying twenty five percent of the cost. But what you're

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Speaker 2: really doing is taking the cost of prescription drugs and

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Speaker 2: rolling them into the deficit. And the same thing goes

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Speaker 2: for Obamacare with all these premium subsidies. Everything that the

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Speaker 2: government does is designed to be popular by being priced

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Speaker 2: below its actual cost, and the result of that in

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Speaker 2: the long run has to be deficit increases and inflation increases.

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Speaker 2: 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 you and

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Speaker 1: I are relatively aligned. I was an acolyte of Professor

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Speaker 1: Leno Graiaz. You'd probably understand where my views are with

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Speaker 1: regard to politics and the role of the government the individual.

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

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Speaker 1: on the Rand and Ron Paul end of things. But

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Speaker 1: what I find frustrating is that people seem to think

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Speaker 1: that somehow government is protecting you and aiding you. But

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Speaker 1: in fact, what goes with that is, you know why

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Speaker 1: you don't feed the bears at the zoo, is they're

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Speaker 1: controlling you. And any government powerful enough to pay for

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

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Speaker 1: it away, and then they start making decisions for you.

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

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Speaker 1: that's where I get very frustrated, because we've now moved

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Speaker 1: beyond healthcare and we've moved into a sort of totalitarian

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Speaker 1: authoritarian control of the individual.

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Speaker 2: Well, you're certainly singing my song because you know you're

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Speaker 2: a libertarian. I'm an adjunct scholar at the Cato Institute.

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Speaker 2: I don't think it gets much more libertarian than that,

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Speaker 2: I would say, so, so we're on the same page

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Speaker 2: as far as you know, being very very concerned about

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Speaker 2: the governmental control. I think that governmental control is part

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Speaker 2: of the story, but I think governmental ineptitude is probably

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Speaker 2: a much bigger part of the story. You know, I'm

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Speaker 2: willing to say, oh, some of those you know, bureaucrats

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Speaker 2: who run these programs actually want to want to help people,

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Speaker 2: and may even believe they are helping people, but it's

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Speaker 2: actually very difficult to run the healthcare system. Well, that's

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Speaker 2: why market forces are so important, because market forces are

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Speaker 2: constantly rewarding providers for figuring out how to serve patients better. Right,

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Speaker 2: that's how you can get business. If you can figure

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Speaker 2: out how to serve your customers better, then you'll get

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Speaker 2: more customers. And that's just something that requires people who

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Speaker 2: know the nuts and bolts really well to be constantly

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Speaker 2: reflecting on how they're doing their jobs. Right. The government bureaucrats,

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Speaker 2: they don't do that. They don't even know how the

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Speaker 2: jobs work. They just exist mainly to pay bills and

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Speaker 2: to enact regulations that enable them to deal with the

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Speaker 2: burden that all this imposes on the federal government. And

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Speaker 2: the results for consumers are just terrible. You know, all

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Speaker 2: these problems that everybody complains about, prior authorization requirements, surprise bills,

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Speaker 2: these things called facility fees that you know, you go

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Speaker 2: to an emergency room, the doctor says, oh, you've got

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Speaker 2: a fever, take some aster and go home, and then

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Speaker 2: you get a bill for ten thousand dollars because you

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Speaker 2: literally because you walked in the front doors. It's just

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Speaker 2: like a cover charge at a bar or something like that,

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Speaker 2: except a lot bigger. You know, none of that stuff

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Speaker 2: exists in the direct payment system. It all exists because

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Speaker 2: the government regulates the way healthcare is delivered, and it

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Speaker 2: does it in stupid ways because it's.

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Speaker 1: Hard to do it right and government's not in the

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Speaker 1: business of efficiency. Professor Charles Silver is our guest. The

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Speaker 1: book is Overcharged, Why you Americans pay too much for healthcare?

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Speaker 2: Fellers and listen to the Michael Berry Show.

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Speaker 3: Good not.

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Speaker 1: Professor Charles Silver of the University of Texas School of

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Speaker 1: Law is our guest. He was I have come to

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Speaker 1: learn in the course of our conversation at ut Law

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Speaker 1: almost ten years before I was there, and still is.

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Speaker 1: I did not know him, but I happened to think

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Speaker 1: the world of that law school, and I gained a

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Speaker 1: lot from being there, both associations and education. And this

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Speaker 1: book has been highly recommended to me by numerous folks

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Speaker 1: as to how to gain a better understanding of why

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Speaker 1: the healthcare system costs you so much overcharged? Why Americans

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Speaker 1: pay too much for healthcare? Professor Charles Silver is our

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Speaker 1: guest professor. Let's talk about young people. By young I'm

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

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Speaker 1: I've read that something like half the healthcare costs in

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Speaker 1: this country are expended on people within the last two

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Speaker 1: years of their lives. And you know, we see this

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Speaker 1: where it's just constant. It's just one thing after another

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

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Speaker 1: in the funeral industry, and I mean it's these are

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Speaker 1: all industries, like the bridal industry and the birthing industry.

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Speaker 1: When you look at a person who is relatively healthy

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Speaker 1: without a chronic condition, and you're looking at the cost

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

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

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

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

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Speaker 1: be in a car wreck or have a heart attack.

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Speaker 1: So we're trying the same way we leverage the risk

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Speaker 1: on if our house burns down, we're trying to kind

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00:27:11,640 --> 00:27:13,720
Speaker 1: of to keep that at bay and to make a

434
00:27:13,760 --> 00:27:19,160
Speaker 1: good financial decision. Where is that going wrong today? Because

435
00:27:19,200 --> 00:27:23,440
Speaker 1: my guess is most people are overpaying for insurance coverage

436
00:27:23,480 --> 00:27:26,680
Speaker 1: that they won't need until much later. That's going toward

437
00:27:26,800 --> 00:27:29,520
Speaker 1: people at their end of life.

438
00:27:30,840 --> 00:27:33,160
Speaker 2: Oh, I agree that I think that story is right.

439
00:27:33,200 --> 00:27:36,000
Speaker 2: There are a bunch of thoughts that it prompts. One

440
00:27:36,080 --> 00:27:37,960
Speaker 2: of them is, you know, I've never been a fan

441
00:27:38,840 --> 00:27:44,320
Speaker 2: of taxing people who are relatively young to provide benefits

442
00:27:44,320 --> 00:27:46,800
Speaker 2: to people who are relatively old. That strikes me is

443
00:27:46,800 --> 00:27:49,399
Speaker 2: wrong on a variety of levels. You know. One is

444
00:27:50,000 --> 00:27:53,480
Speaker 2: every moral theory that I know of says you move

445
00:27:53,640 --> 00:27:58,520
Speaker 2: money from richer people to poorer people. Well, older people

446
00:27:58,560 --> 00:28:02,760
Speaker 2: are wealthier younger people. That shouldn't be surprising to anybody.

447
00:28:02,760 --> 00:28:05,040
Speaker 2: They've had their whole lives to work right and save.

448
00:28:05,160 --> 00:28:07,480
Speaker 2: They've paid off their cars, they've paid off their homes.

449
00:28:07,520 --> 00:28:11,000
Speaker 2: You know, they have other assets. Right, They're on average,

450
00:28:11,160 --> 00:28:13,919
Speaker 2: much wealthier than younger people who are struggling, you know,

451
00:28:14,040 --> 00:28:18,240
Speaker 2: raising families, you know, just getting jobs, dealing with college

452
00:28:18,280 --> 00:28:21,639
Speaker 2: debt and all that stuff. So my moral view is,

453
00:28:21,680 --> 00:28:23,560
Speaker 2: if we were going to move money in any direction,

454
00:28:23,640 --> 00:28:25,919
Speaker 2: we should move it from older people to younger people.

455
00:28:26,000 --> 00:28:28,840
Speaker 2: But our system does the reverse. We're robbing the poor

456
00:28:28,920 --> 00:28:34,239
Speaker 2: to pay the rich. I don't understand that. Another thing is,

457
00:28:36,760 --> 00:28:45,840
Speaker 2: excuse me, the system really disserves people because it eliminates

458
00:28:45,960 --> 00:28:49,120
Speaker 2: all caps on spending. You were talking about end of

459
00:28:49,160 --> 00:28:51,760
Speaker 2: life care and how we spend so much money in

460
00:28:51,760 --> 00:28:55,080
Speaker 2: the last year or two of people's lives. Well, if

461
00:28:55,080 --> 00:28:57,920
Speaker 2: people had to spend their own money, nobody would spend

462
00:28:57,920 --> 00:29:02,000
Speaker 2: an infinite amount in their last two years on healthcare.

463
00:29:02,320 --> 00:29:04,520
Speaker 2: They would have to make hard decisions, right, These are

464
00:29:04,560 --> 00:29:08,440
Speaker 2: not pleasant decisions, but they would make decisions about how

465
00:29:08,520 --> 00:29:11,640
Speaker 2: much healthcare they want. Is it worth spending a million

466
00:29:11,720 --> 00:29:14,800
Speaker 2: dollars to extend my life by a month, Right, that's

467
00:29:14,840 --> 00:29:18,520
Speaker 2: the kind of decision they would have to make. Well, today,

468
00:29:18,560 --> 00:29:22,600
Speaker 2: because we removed all caps from the system, nobody has

469
00:29:22,600 --> 00:29:26,240
Speaker 2: to make those decisions. Instead, we just spend literally an

470
00:29:26,280 --> 00:29:29,720
Speaker 2: infinite amount of money on people who are in the

471
00:29:29,760 --> 00:29:32,840
Speaker 2: final stages of their illness. We get no bang for

472
00:29:32,880 --> 00:29:35,520
Speaker 2: the buck. You know, we have people, literally we have

473
00:29:35,600 --> 00:29:39,440
Speaker 2: people who are receiving cancer treatments, new cancer treatments that

474
00:29:39,520 --> 00:29:43,160
Speaker 2: cost a million dollars, and all those treatments do is

475
00:29:43,200 --> 00:29:46,120
Speaker 2: extend their lives by about a month. And it's not

476
00:29:46,360 --> 00:29:48,920
Speaker 2: even a good month. It's not a month when you're

477
00:29:48,960 --> 00:29:51,600
Speaker 2: going to be out there on the golf course playing

478
00:29:51,640 --> 00:29:54,080
Speaker 2: with your buddies and drinking beer. It's a month like

479
00:29:54,160 --> 00:29:58,520
Speaker 2: you're in the hospital, right for the whole month. These

480
00:29:58,560 --> 00:30:01,720
Speaker 2: things just make no sense. But the government, the government

481
00:30:01,840 --> 00:30:07,040
Speaker 2: cannot make those decisions. Literally, it cannot because the moment

482
00:30:07,120 --> 00:30:11,360
Speaker 2: the government starts talking about rationing care, everybody loses their

483
00:30:11,480 --> 00:30:15,120
Speaker 2: minds and you don't want to be the politician that

484
00:30:15,280 --> 00:30:21,800
Speaker 2: they're rallying against. Right, So the government simply ignores the

485
00:30:21,840 --> 00:30:25,080
Speaker 2: need to make these decisions and just spends endless amounts

486
00:30:25,080 --> 00:30:27,680
Speaker 2: of money because it's other people's money. So why does

487
00:30:27,680 --> 00:30:33,320
Speaker 2: the government care? Right, And you know, we just have

488
00:30:33,440 --> 00:30:36,920
Speaker 2: to come back to the world in which people are

489
00:30:37,200 --> 00:30:41,760
Speaker 2: responsible for their own end of life care. You know,

490
00:30:41,920 --> 00:30:44,480
Speaker 2: it's it's it's a sad thing, but it's true. We

491
00:30:44,520 --> 00:30:48,400
Speaker 2: will all die at some point, and the fact that

492
00:30:48,440 --> 00:30:51,960
Speaker 2: we will all die at some point affects a thousand

493
00:30:52,000 --> 00:30:54,880
Speaker 2: decisions that each of us makes. Right, when am I

494
00:30:54,920 --> 00:30:58,440
Speaker 2: going to stop working? Well, if I'm thinking I don't

495
00:30:58,440 --> 00:31:00,320
Speaker 2: have much longer to live, I had probably we will

496
00:31:00,320 --> 00:31:02,320
Speaker 2: stop working so I can spend my last you know,

497
00:31:02,360 --> 00:31:05,440
Speaker 2: a couple of years with my family or traveling or

498
00:31:05,440 --> 00:31:07,520
Speaker 2: whatever it is, right, I mean, if you start to

499
00:31:07,520 --> 00:31:10,360
Speaker 2: think about it, knowing that at some point we will

500
00:31:10,360 --> 00:31:15,400
Speaker 2: all die, it affects, as I said, thousands of decisions

501
00:31:15,480 --> 00:31:17,760
Speaker 2: that we make. You know, do I want to live

502
00:31:17,800 --> 00:31:19,880
Speaker 2: in this house that I'm in now until the end

503
00:31:19,920 --> 00:31:21,360
Speaker 2: of my life? Or do I want to move to

504
00:31:21,400 --> 00:31:25,560
Speaker 2: a house that's more handicap equipped and things of that sort. Right,

505
00:31:26,240 --> 00:31:29,480
Speaker 2: this is just another decision. It's a tough decision. I'm

506
00:31:29,480 --> 00:31:32,080
Speaker 2: not trying to say otherwise, but it's a decision that

507
00:31:32,160 --> 00:31:34,640
Speaker 2: needs to be made, and it needs to be made

508
00:31:34,720 --> 00:31:37,280
Speaker 2: not by the government, but by the people who are

509
00:31:37,320 --> 00:31:41,320
Speaker 2: directly involved and who can think hard about all these

510
00:31:41,440 --> 00:31:43,880
Speaker 2: tough problems. There's no way the government's going to make

511
00:31:43,880 --> 00:31:47,000
Speaker 2: a good decision. Their incentives are wrong, their knowledge is

512
00:31:47,000 --> 00:31:50,760
Speaker 2: too limited. They don't have access to the counselors that

513
00:31:50,840 --> 00:31:54,800
Speaker 2: individuals will talk to when making these kinds of decisions. So,

514
00:31:55,280 --> 00:31:57,240
Speaker 2: you know, we just have to get the government out

515
00:31:57,320 --> 00:32:02,840
Speaker 2: of this business. What I have proposed is that we can.

516
00:32:02,960 --> 00:32:04,840
Speaker 2: You know, there is one other problem though that we

517
00:32:04,920 --> 00:32:07,400
Speaker 2: haven't discussed, which we do need to discuss, which is,

518
00:32:07,400 --> 00:32:10,480
Speaker 2: there are some people who are too poor to afford

519
00:32:11,040 --> 00:32:14,360
Speaker 2: fundamental health care. We do need to come up with

520
00:32:14,400 --> 00:32:16,920
Speaker 2: a way of dealing with those people, because when they

521
00:32:16,920 --> 00:32:20,160
Speaker 2: show up at the hospital needing healthcare, they're not going

522
00:32:20,200 --> 00:32:22,480
Speaker 2: to be turned away. Right now, We're not going to

523
00:32:22,480 --> 00:32:25,120
Speaker 2: be having sick people dying in the streets because they

524
00:32:25,160 --> 00:32:28,360
Speaker 2: can't afford healthcare. So we need to come up with

525
00:32:28,400 --> 00:32:30,800
Speaker 2: a way to deal with that. But the obvious way

526
00:32:30,840 --> 00:32:33,080
Speaker 2: to deal with that is through a negative income text,

527
00:32:33,320 --> 00:32:36,200
Speaker 2: the sort of thing that Milton Friedman proposed. You know,

528
00:32:36,240 --> 00:32:40,680
Speaker 2: you provide everybody with a kind of amount of sustenance

529
00:32:40,720 --> 00:32:42,720
Speaker 2: that they can use for this purpose. You could put

530
00:32:42,720 --> 00:32:46,600
Speaker 2: it into a restricted medical account if you wanted. But

531
00:32:46,680 --> 00:32:49,000
Speaker 2: the idea is once you give it to them, it's

532
00:32:49,080 --> 00:32:51,360
Speaker 2: hands off for the rest of it. The government doesn't

533
00:32:51,360 --> 00:32:55,240
Speaker 2: get involved in the delivery of healthcare. Just people make

534
00:32:55,320 --> 00:32:59,600
Speaker 2: decisions on themselves with their own money, and life goes forward.

535
00:32:59,640 --> 00:33:01,840
Speaker 2: And I think if we did that, the healthcare system

536
00:33:01,840 --> 00:33:04,240
Speaker 2: would operate much more efficiently.

537
00:33:04,560 --> 00:33:09,360
Speaker 1: Well, the great frustration, as you know, is that everybody

538
00:33:09,360 --> 00:33:12,080
Speaker 1: gets a vote, even people that make bad decisions, and

539
00:33:12,120 --> 00:33:15,560
Speaker 1: that many people make bad decisions. You know, we will

540
00:33:15,560 --> 00:33:17,840
Speaker 1: have a lot of people who say I can't afford

541
00:33:17,920 --> 00:33:20,719
Speaker 1: medical care because they don't save money. But they've got

542
00:33:20,720 --> 00:33:23,960
Speaker 1: a big screen TV in every room, and they've got,

543
00:33:24,200 --> 00:33:26,640
Speaker 1: you know, a car they can't afford that they're driving.

544
00:33:27,560 --> 00:33:29,200
Speaker 1: They end up with the car that they can't afford,

545
00:33:29,280 --> 00:33:31,400
Speaker 1: and we end up paying for the health care that

546
00:33:31,440 --> 00:33:35,560
Speaker 1: they can't afford. The book is Overcharged, Why Americans Pay

547
00:33:35,600 --> 00:33:39,480
Speaker 1: Too Much for Healthcare? Professor Charles Silver. But everybody knows

548
00:33:39,480 --> 00:33:40,320
Speaker 1: who this guy is.

549
00:33:40,360 --> 00:33:44,120
Speaker 2: Come on, man, mit the Michael Berry, Come on.

550
00:33:49,600 --> 00:33:52,320
Speaker 1: Professor Charles Silver is our guest. It's a subject of

551
00:33:52,360 --> 00:33:55,160
Speaker 1: great interest to me and to many of you. The

552
00:33:55,200 --> 00:34:00,680
Speaker 1: book is called Overcharged, Why Americans Pay Too Much for Healthcare.

553
00:34:00,800 --> 00:34:04,280
Speaker 1: He is a law professor at the University of Texas

554
00:34:04,720 --> 00:34:08,640
Speaker 1: at Austin School of Law. And we ended the last

555
00:34:08,719 --> 00:34:11,680
Speaker 1: segment with the discussion that at the end of the day,

556
00:34:12,320 --> 00:34:16,040
Speaker 1: the allocation of scarce resources and who will make that decision.

557
00:34:16,840 --> 00:34:21,600
Speaker 1: We're back at that point again. In every family, you know,

558
00:34:21,640 --> 00:34:26,240
Speaker 1: you got eight kids and you've got one chicken. Mom

559
00:34:26,280 --> 00:34:28,640
Speaker 1: says you're not getting a second piece. So there's some

560
00:34:28,680 --> 00:34:33,520
Speaker 1: cartilage left on that leg. If you're hungry, you'll eat that.

561
00:34:34,239 --> 00:34:37,040
Speaker 1: And there comes a point where we have to decide,

562
00:34:37,760 --> 00:34:41,520
Speaker 1: with scarce resources, who will make the decision as to

563
00:34:41,520 --> 00:34:44,680
Speaker 1: where those resources will be deployed. Will it be the

564
00:34:44,680 --> 00:34:48,160
Speaker 1: government or will it be the individual? And if it's

565
00:34:48,200 --> 00:34:52,000
Speaker 1: the individual, there will be those who say, well, I

566
00:34:52,120 --> 00:34:54,840
Speaker 1: want as much as my neighbor has. Okay, we'll earn

567
00:34:54,880 --> 00:34:59,280
Speaker 1: the money to purchase that. Well, I don't earn as much.

568
00:34:59,640 --> 00:35:02,319
Speaker 1: Want to use the power of the gun at the

569
00:35:02,360 --> 00:35:04,480
Speaker 1: direction of the government that I they're more of me

570
00:35:04,560 --> 00:35:06,560
Speaker 1: than there are of the rich people I vote for.

571
00:35:06,760 --> 00:35:09,840
Speaker 1: I want that well. The only alternative is for the

572
00:35:09,840 --> 00:35:14,000
Speaker 1: government to do it. Professor I. Hearken back to a study,

573
00:35:14,040 --> 00:35:16,720
Speaker 1: and it's been a while since I read this book.

574
00:35:17,680 --> 00:35:22,040
Speaker 1: It's interesting because I'm a believer and let the marketplace decide.

575
00:35:22,280 --> 00:35:24,359
Speaker 1: You know, healthcare is the one area where we think

576
00:35:24,360 --> 00:35:27,120
Speaker 1: everybody gets all the healthcare they want, but we all

577
00:35:27,200 --> 00:35:28,960
Speaker 1: end up paying for that. We don't say everybody gets

578
00:35:28,960 --> 00:35:30,759
Speaker 1: all the food they want, or all the cars they want,

579
00:35:30,840 --> 00:35:32,480
Speaker 1: or all the houses they want, or all the clothes

580
00:35:32,480 --> 00:35:35,000
Speaker 1: they want, but for some reason, everybody gets all the

581
00:35:35,000 --> 00:35:38,000
Speaker 1: healthcare they want, even at the point that it's throwing

582
00:35:38,000 --> 00:35:41,759
Speaker 1: good money after bad, so socialist system the opposite of

583
00:35:41,800 --> 00:35:45,480
Speaker 1: what I propose. In Sweden, they did a study and

584
00:35:45,520 --> 00:35:47,920
Speaker 1: it was a multi decade study you may be aware

585
00:35:47,920 --> 00:35:51,680
Speaker 1: of it, on prostate cancer in men, and they determined

586
00:35:51,920 --> 00:35:56,919
Speaker 1: that out of I think it was three thousand men

587
00:35:56,960 --> 00:36:00,840
Speaker 1: who had prostate cancer who were diagnosed with prostate cancer

588
00:36:01,440 --> 00:36:05,719
Speaker 1: and they chose not to treat the prostate cancer. And

589
00:36:06,040 --> 00:36:09,200
Speaker 1: they did about a twenty five year study and the

590
00:36:09,320 --> 00:36:12,920
Speaker 1: number of men who died of untreated prostate cancer was

591
00:36:12,960 --> 00:36:16,719
Speaker 1: something like thirty out of three thousand. So they came

592
00:36:16,760 --> 00:36:20,960
Speaker 1: to the conclusion with a government, completely government run system

593
00:36:21,239 --> 00:36:24,319
Speaker 1: that with scarce resources, it does not make sense for

594
00:36:24,440 --> 00:36:29,680
Speaker 1: us to treat prostate cancer per se because nobody, very

595
00:36:29,680 --> 00:36:32,359
Speaker 1: few people are going to die of prostate cancer. Let's

596
00:36:32,400 --> 00:36:34,840
Speaker 1: spend our money on other things that if we don't

597
00:36:34,880 --> 00:36:39,320
Speaker 1: spend it there you die. And it strikes me that

598
00:36:39,440 --> 00:36:42,799
Speaker 1: while that's the opposite of the capitalist system, there does

599
00:36:42,920 --> 00:36:46,080
Speaker 1: need to be an understanding that we're wasting a lot

600
00:36:46,120 --> 00:36:50,279
Speaker 1: of money on studies because and this gets to the

601
00:36:50,320 --> 00:36:52,880
Speaker 1: second point of what you've written a lot about medical

602
00:36:52,920 --> 00:36:56,560
Speaker 1: malpractice and the fear of medical malpractice. I don't think

603
00:36:56,640 --> 00:36:59,160
Speaker 1: everybody needs a glaucoma test every time they go for

604
00:36:59,800 --> 00:37:02,840
Speaker 1: a you know, their license, but God forbid one person

605
00:37:02,920 --> 00:37:07,560
Speaker 1: not be diagnosed with glaucoma. We're practicing defensive medicine. We're

606
00:37:07,719 --> 00:37:11,000
Speaker 1: over ordering tests, which is a waste of our time

607
00:37:11,040 --> 00:37:15,080
Speaker 1: and energy but also money, and we're not actually doing

608
00:37:15,120 --> 00:37:19,759
Speaker 1: We're not engaged in what I would consider smart effective

609
00:37:20,160 --> 00:37:23,960
Speaker 1: healing because everyone is afraid of being sued. And that

610
00:37:24,200 --> 00:37:27,200
Speaker 1: has we get back to our point. The book is overcharged.

611
00:37:27,200 --> 00:37:29,959
Speaker 1: Why Americans pay too much for healthcare? I think that's

612
00:37:29,960 --> 00:37:31,640
Speaker 1: a big portion of what we spend.

613
00:37:31,840 --> 00:37:36,239
Speaker 2: Your thought, well, I'm going to disagree with part of that,

614
00:37:36,320 --> 00:37:39,800
Speaker 2: but I agree with a lot of it as well.

615
00:37:40,800 --> 00:37:44,239
Speaker 2: In my world, when you have a self interested explanation

616
00:37:44,600 --> 00:37:47,359
Speaker 2: for something, you probably don't have to look very far

617
00:37:47,440 --> 00:37:50,720
Speaker 2: for any other explanation. Self interest usually is a pretty

618
00:37:50,760 --> 00:37:55,719
Speaker 2: good explanation. And the reason, you know, some people say, oh,

619
00:37:55,800 --> 00:37:58,640
Speaker 2: the reason that doctors overtreat is because they're afraid of

620
00:37:58,680 --> 00:38:02,759
Speaker 2: being sued. Well, there's a simpler self interested explanation, which

621
00:38:02,800 --> 00:38:06,600
Speaker 2: is every time they treat somebody, they make money. And

622
00:38:07,239 --> 00:38:11,200
Speaker 2: until you take the profit out of these services, which

623
00:38:11,239 --> 00:38:15,319
Speaker 2: will never happen. It's very hard to determine that they're

624
00:38:15,360 --> 00:38:21,359
Speaker 2: actually engaging in any real defensive medicine at all. There

625
00:38:21,400 --> 00:38:24,120
Speaker 2: are lots of studies that are out there now that

626
00:38:24,200 --> 00:38:27,239
Speaker 2: have found that, I mean, defensive medicine is kind of

627
00:38:27,280 --> 00:38:32,279
Speaker 2: hard to define because it can be both. It can

628
00:38:32,320 --> 00:38:35,920
Speaker 2: be both the provision of services that aren't needed and

629
00:38:35,960 --> 00:38:39,799
Speaker 2: the avoidance of services that are needed, because you get

630
00:38:39,840 --> 00:38:42,600
Speaker 2: sued when you do deliver services as well as when

631
00:38:42,600 --> 00:38:46,240
Speaker 2: you withhold them. So it's hard to figure out exactly

632
00:38:46,280 --> 00:38:48,719
Speaker 2: what's going on with defensive medicine. But as I said,

633
00:38:48,800 --> 00:38:50,680
Speaker 2: I don't think we really need to worry about it

634
00:38:50,800 --> 00:38:54,080
Speaker 2: very much because we have a self interested explanation, which

635
00:38:54,120 --> 00:38:57,480
Speaker 2: is that the services are profitable. And there's also you know,

636
00:38:57,600 --> 00:39:00,719
Speaker 2: doctors have a lot of confidence in their ability to

637
00:39:00,760 --> 00:39:03,120
Speaker 2: help people, and they have a very strong desire to

638
00:39:03,239 --> 00:39:03,880
Speaker 2: help people.

639
00:39:04,000 --> 00:39:06,000
Speaker 1: Right at least that's what it should be.

640
00:39:06,360 --> 00:39:06,600
Speaker 2: You know.

641
00:39:06,680 --> 00:39:10,680
Speaker 1: You remind me of another great document written in seventeen

642
00:39:10,760 --> 00:39:14,120
Speaker 1: seventy six, and that from a Scotsman named Adam Smith,

643
00:39:14,160 --> 00:39:16,640
Speaker 1: who famously said, it is not from the benevolence of

644
00:39:16,680 --> 00:39:19,000
Speaker 1: the butcher, or the brewer or the baker that we

645
00:39:19,080 --> 00:39:23,120
Speaker 1: expect our dinner, but from their regard to their own

646
00:39:23,280 --> 00:39:29,760
Speaker 1: self interest, and exactly self interest drives so many things.

647
00:39:30,120 --> 00:39:32,759
Speaker 1: That guy is not standing on his feet behind the

648
00:39:32,800 --> 00:39:34,960
Speaker 1: counter at the donut shop for so many hours and

649
00:39:35,000 --> 00:39:37,439
Speaker 1: didn't get there at two thirty this morning because he's

650
00:39:37,480 --> 00:39:40,919
Speaker 1: a nice guy. He wants to make a profit off

651
00:39:40,960 --> 00:39:43,600
Speaker 1: the donuts. I get to enjoy the donuts in exchange

652
00:39:43,640 --> 00:39:46,720
Speaker 1: for the currency that I was given for the sweat

653
00:39:46,719 --> 00:39:49,359
Speaker 1: of my brow. It works, and I think we have

654
00:39:49,440 --> 00:39:51,600
Speaker 1: to return that to the process. And I think that's

655
00:39:51,600 --> 00:39:53,080
Speaker 1: where you and I can agree.

656
00:39:54,280 --> 00:39:56,040
Speaker 2: I think we do agree on that, but we also

657
00:39:56,120 --> 00:40:02,400
Speaker 2: agree that I mean, these social programs have fundamentally undermined

658
00:40:02,719 --> 00:40:09,600
Speaker 2: the incentive to save and to be self reliant, you know,

659
00:40:09,719 --> 00:40:14,240
Speaker 2: the I think you know. I constantly read articles about

660
00:40:14,320 --> 00:40:17,560
Speaker 2: how many people are retiring and all they have to

661
00:40:17,640 --> 00:40:20,319
Speaker 2: live on is social Security and medicare They don't have

662
00:40:20,440 --> 00:40:23,759
Speaker 2: much in the way of savings. And people say, well,

663
00:40:23,800 --> 00:40:27,040
Speaker 2: how could you possibly, you know, let that happen, right?

664
00:40:27,080 --> 00:40:29,400
Speaker 2: Why are you buying, as you put it, those you know,

665
00:40:30,040 --> 00:40:32,400
Speaker 2: big screen TVs for every room when you should be

666
00:40:32,440 --> 00:40:35,799
Speaker 2: saving for your later years. I think the answer is

667
00:40:35,800 --> 00:40:38,520
Speaker 2: that most people naively think, Oh, the government's just going

668
00:40:38,600 --> 00:40:41,080
Speaker 2: to take care of me in my later years, so

669
00:40:41,400 --> 00:40:44,480
Speaker 2: I don't have to save, and they, you know, the

670
00:40:44,560 --> 00:40:48,399
Speaker 2: temptation to spend money now rather than later, it's always there.

671
00:40:48,480 --> 00:40:52,880
Speaker 2: Who wants to save? Saving is boring right? Consuming today

672
00:40:53,000 --> 00:40:57,399
Speaker 2: is fun. So you know, I think that as long

673
00:40:57,440 --> 00:41:01,560
Speaker 2: as we have these paygo program where you know, you

674
00:41:01,600 --> 00:41:04,919
Speaker 2: can keep getting money out above what you put in,

675
00:41:06,600 --> 00:41:10,840
Speaker 2: that the incentives to save will forever be undermined. And

676
00:41:11,239 --> 00:41:13,680
Speaker 2: that's a terrible thing, I think, because, as you said,

677
00:41:13,719 --> 00:41:17,000
Speaker 2: you know, we're just getting ourselves into this world where

678
00:41:17,520 --> 00:41:20,160
Speaker 2: each of us expects everybody else to pay for everything

679
00:41:20,200 --> 00:41:24,120
Speaker 2: that we need. If it's only healthcare, they still expect

680
00:41:24,120 --> 00:41:26,880
Speaker 2: to pay for everything that they want, and that just

681
00:41:27,080 --> 00:41:30,719
Speaker 2: drives costs through the roof without really any offsetting benefits

682
00:41:30,719 --> 00:41:31,759
Speaker 2: that make sense of it.

683
00:41:32,280 --> 00:41:37,880
Speaker 3: Zoologists will tell you are doing great harm by domesticating

684
00:41:38,080 --> 00:41:42,000
Speaker 3: certain breeds of animals, particularly if you intend at some

685
00:41:42,120 --> 00:41:44,240
Speaker 3: point to release them into the wild.

686
00:41:44,320 --> 00:41:48,160
Speaker 1: You make them slaves. They lose the very abilities, and

687
00:41:48,200 --> 00:41:52,000
Speaker 1: we've seen with evolutionary studies that teeth are not as

688
00:41:52,000 --> 00:41:54,600
Speaker 1: sharp any longer, claws are not as sharp any more.

689
00:41:54,760 --> 00:41:57,440
Speaker 1: They can no longer run as fast. They grow to

690
00:41:57,560 --> 00:42:02,200
Speaker 1: be like prison inmates, depend on someone else to provide

691
00:42:02,200 --> 00:42:06,000
Speaker 1: for them, and I think that has to be understood

692
00:42:06,040 --> 00:42:09,319
Speaker 1: by people. Our guest is Professor Charles Silver, who will

693
00:42:09,360 --> 00:42:12,240
Speaker 1: be with us for one more segment. The book is Overcharged?

694
00:42:12,920 --> 00:42:16,000
Speaker 1: Why Americans pay too much for us?

695
00:42:16,760 --> 00:42:20,160
Speaker 2: That's it. Arrest me or take me to Texas because

696
00:42:20,160 --> 00:42:22,440
Speaker 2: I don't ready to get out of this state. I

697
00:42:22,520 --> 00:42:26,360
Speaker 2: think Michael Berry Rocks show I like it.

698
00:42:29,680 --> 00:42:33,279
Speaker 1: Professor Charles Silver of the University of Texas School of Law,

699
00:42:33,400 --> 00:42:37,360
Speaker 1: my alma mater, has graciously spent quite a bit of

700
00:42:37,440 --> 00:42:42,239
Speaker 1: time with us discussing an area of his academic expertise

701
00:42:42,280 --> 00:42:45,560
Speaker 1: and prowess. The book is Overcharged, Why Americans pay too

702
00:42:45,640 --> 00:42:48,560
Speaker 1: much for healthcare? And Folks, I have to say, as

703
00:42:49,080 --> 00:42:53,799
Speaker 1: you've heard me say many times, politics is interesting, you know,

704
00:42:54,120 --> 00:42:57,840
Speaker 1: the rooting for your team versus that team, the Trump Dance,

705
00:42:57,960 --> 00:43:01,440
Speaker 1: the reds and Blues, and who shows up. But my

706
00:43:01,640 --> 00:43:04,040
Speaker 1: primary interest at the end of the day is not

707
00:43:04,200 --> 00:43:07,160
Speaker 1: my team winning and your team losing. My primary interest

708
00:43:07,400 --> 00:43:12,520
Speaker 1: is creating a structure where the individual can thrive, where

709
00:43:12,560 --> 00:43:17,440
Speaker 1: there is opportunity and fairness, safeguard's rule of law, and

710
00:43:18,160 --> 00:43:21,239
Speaker 1: that will, at the end of the day, advance humanity.

711
00:43:21,440 --> 00:43:24,160
Speaker 1: It always has. It's the only thing that does not government.

712
00:43:24,680 --> 00:43:28,600
Speaker 1: And so these sort of policy discussions, I understand, are

713
00:43:28,680 --> 00:43:32,640
Speaker 1: probably less thrilling than my usual screaming and hollering about

714
00:43:33,239 --> 00:43:36,000
Speaker 1: this or that indignity of the day. But this is

715
00:43:36,040 --> 00:43:40,040
Speaker 1: what matters. This is why we get involved in campaigns,

716
00:43:40,680 --> 00:43:42,680
Speaker 1: is to take control of the government and get it

717
00:43:42,719 --> 00:43:46,280
Speaker 1: out of our lives and create safeguards and reduce regulation

718
00:43:46,880 --> 00:43:49,680
Speaker 1: and promote the rule of law so that hardworking people

719
00:43:49,760 --> 00:43:52,560
Speaker 1: can create enough John Gault style for the rest of

720
00:43:52,640 --> 00:43:56,359
Speaker 1: us to prosper. And this stuff matters. So that's why

721
00:43:56,400 --> 00:44:02,200
Speaker 1: we have these conversations. Professor Charlesolver, overcharged, why Americans pay

722
00:44:02,280 --> 00:44:05,319
Speaker 1: too much for healthcare? Professor Silver, I want you to

723
00:44:05,360 --> 00:44:10,200
Speaker 1: be king for a day. You have no as this

724
00:44:10,360 --> 00:44:16,880
Speaker 1: benevolent monarch, you have no political concerns. Reconstruct our health

725
00:44:16,920 --> 00:44:20,720
Speaker 1: care facility to provide an opportunity for the most healing

726
00:44:20,800 --> 00:44:24,200
Speaker 1: to occur and the individuals to take control of their

727
00:44:24,239 --> 00:44:25,920
Speaker 1: own healthcare. What does that look like?

728
00:44:28,480 --> 00:44:31,640
Speaker 2: Wow, I'm nervous about being king for a day because

729
00:44:32,000 --> 00:44:33,480
Speaker 2: I don't believe in kings.

730
00:44:33,320 --> 00:44:36,120
Speaker 1: I know, but no, I'll try.

731
00:44:38,000 --> 00:44:41,560
Speaker 2: I think we basically wipe away everything in terms of

732
00:44:42,600 --> 00:44:47,360
Speaker 2: these programs and the restrictive regulations. You know, have you

733
00:44:47,360 --> 00:44:49,920
Speaker 2: ever heard of a certificate of need law? I don't know.

734
00:44:50,160 --> 00:44:54,400
Speaker 2: They're called con laws by for short, but con laws

735
00:44:56,160 --> 00:45:00,920
Speaker 2: regulate how many new healthcare providers can set up shops.

736
00:45:00,920 --> 00:45:02,799
Speaker 2: So if you want to open a hospital, you got

737
00:45:02,800 --> 00:45:06,040
Speaker 2: to get permission. But guess what the way the con

738
00:45:06,160 --> 00:45:10,960
Speaker 2: laws work, the existing hospitals have a vote and whether

739
00:45:11,000 --> 00:45:13,520
Speaker 2: you can open a new hospital or not. They're like

740
00:45:13,560 --> 00:45:17,480
Speaker 2: giving McDonald's a vote on whether Burger King can open

741
00:45:17,520 --> 00:45:21,279
Speaker 2: a restaurant right across the street. It just doesn't make

742
00:45:21,320 --> 00:45:23,759
Speaker 2: any sense, but that's the way I would get rid

743
00:45:23,800 --> 00:45:28,000
Speaker 2: of all of those supply constraining regulations, and I would

744
00:45:28,000 --> 00:45:33,120
Speaker 2: get rid of all of these programs Obamacare, Medicare, whatever,

745
00:45:33,960 --> 00:45:39,640
Speaker 2: and I would go to a very simple wealth distribution program.

746
00:45:39,719 --> 00:45:42,040
Speaker 2: I'm not sure exactly how much money it should be.

747
00:45:42,280 --> 00:45:44,400
Speaker 2: That's something that has to have some work done. But

748
00:45:44,440 --> 00:45:46,719
Speaker 2: you know we're currently spending if you put all the

749
00:45:46,800 --> 00:45:52,719
Speaker 2: healthcare programs together, you know we're spending like seven eight

750
00:45:52,840 --> 00:45:56,520
Speaker 2: ten thousand dollars a person per you know, per American

751
00:45:56,600 --> 00:45:59,239
Speaker 2: through these programs, If we just took some of that

752
00:45:59,400 --> 00:46:05,160
Speaker 2: money and started plunking it into restricted healthcare savings accounts

753
00:46:05,160 --> 00:46:07,480
Speaker 2: for people, so every year, you know, there's just a

754
00:46:07,520 --> 00:46:10,839
Speaker 2: little bit more that's put in. Pretty soon, everybody would

755
00:46:10,880 --> 00:46:13,799
Speaker 2: have enough money to pay for their basic needs and

756
00:46:13,880 --> 00:46:17,040
Speaker 2: to buy catastrophic insurance. And I would let people buy

757
00:46:17,880 --> 00:46:21,600
Speaker 2: just as much catastrophic insurance as they want. I wouldn't

758
00:46:21,600 --> 00:46:24,759
Speaker 2: have coverage mandates. You know, right now, if you want

759
00:46:24,760 --> 00:46:27,600
Speaker 2: to buy a policy on one of the exchanges and

760
00:46:27,640 --> 00:46:32,840
Speaker 2: you're a young man, you know you have to pay

761
00:46:32,880 --> 00:46:37,960
Speaker 2: for annual mammograms, right, but you're not getting mamograms because

762
00:46:38,000 --> 00:46:41,800
Speaker 2: you're a man, right right, So you know, I wouldn't

763
00:46:41,840 --> 00:46:45,279
Speaker 2: force people to buy any particular amount of coverage. And

764
00:46:45,320 --> 00:46:49,560
Speaker 2: I would let insurance companies limit the total payouts, which

765
00:46:50,160 --> 00:46:54,040
Speaker 2: you know, that's really where things are screwed up right now.

766
00:46:54,120 --> 00:46:55,799
Speaker 2: It's one of the areas, right they have to spend

767
00:46:55,920 --> 00:46:59,160
Speaker 2: unlimited amounts of money on people. I would let people

768
00:46:59,239 --> 00:47:03,719
Speaker 2: let design their our own insurance programs. And I think

769
00:47:03,800 --> 00:47:05,879
Speaker 2: that you know, it's not gonna work perfectly. Nothing ever

770
00:47:05,920 --> 00:47:08,880
Speaker 2: works perfectly, right, but it would work so much better

771
00:47:09,440 --> 00:47:12,760
Speaker 2: and be so much more efficient than the existing system,

772
00:47:12,800 --> 00:47:16,759
Speaker 2: and it'd be way more consumer friendly. And that's a

773
00:47:16,880 --> 00:47:21,160
Speaker 2: huge improvement because I don't know anybody who is happy

774
00:47:21,200 --> 00:47:24,880
Speaker 2: with the existing healthcare system. I mean, this terrible murder

775
00:47:24,880 --> 00:47:31,080
Speaker 2: that just occurred has brought to the surface the extraordinary

776
00:47:31,200 --> 00:47:36,440
Speaker 2: hatred that people have toward insurance companies. You know, that's

777
00:47:36,600 --> 00:47:40,120
Speaker 2: just one symptom. We're spending twice as much as any

778
00:47:40,160 --> 00:47:43,719
Speaker 2: other country on healthcare, and we're getting less and less

779
00:47:43,719 --> 00:47:48,520
Speaker 2: healthy every year. You know, our life expectancy is declining.

780
00:47:49,000 --> 00:47:51,799
Speaker 2: We're just doing everything wrong that we possibly can do.

781
00:47:51,920 --> 00:47:54,840
Speaker 2: So wipe the slate, get rid of all this stuff.

782
00:47:54,920 --> 00:47:59,239
Speaker 2: Start out with a really simple direct payment system and

783
00:47:59,280 --> 00:48:01,839
Speaker 2: a cash trainansfer a system to deal with people who

784
00:48:01,840 --> 00:48:04,920
Speaker 2: are so poor that they can't even afford the basics,

785
00:48:05,920 --> 00:48:09,000
Speaker 2: and just be satisfied with that. I said, It's not

786
00:48:09,000 --> 00:48:11,799
Speaker 2: gonna be perfect, but it'd be hard to improve on all.

787
00:48:11,880 --> 00:48:16,200
Speaker 1: Right, Yeah, And to get outside the purview of what

788
00:48:16,239 --> 00:48:19,040
Speaker 1: we've discussed, but to speak more to the process that

789
00:48:19,160 --> 00:48:23,120
Speaker 1: lands us where we are. Our criminal justice system. We

790
00:48:23,200 --> 00:48:28,080
Speaker 1: spend more on imprisoning and prosecuting and chasing down bad

791
00:48:28,120 --> 00:48:30,719
Speaker 1: guys in any other country in the world, and yet

792
00:48:30,920 --> 00:48:33,879
Speaker 1: I think we do a far worse job, at less

793
00:48:33,880 --> 00:48:36,800
Speaker 1: effective job than most countries in the world. And I

794
00:48:36,840 --> 00:48:40,520
Speaker 1: think much of that can you can see some similarities

795
00:48:40,520 --> 00:48:45,120
Speaker 1: and patterns that pervade those two industries. And by the way,

796
00:48:45,600 --> 00:48:49,160
Speaker 1: then we could move over into public education and education generally.

797
00:48:51,080 --> 00:48:54,640
Speaker 1: There are a number of different applications for where this

798
00:48:54,760 --> 00:49:00,719
Speaker 1: process has gone wrong, and it is frustrating. I very

799
00:49:00,840 --> 00:49:07,279
Speaker 1: much appreciate your time, Professor. I feel the better for it.

800
00:49:07,719 --> 00:49:11,600
Speaker 1: The book is overcharged Why Americans pay too much for

801
00:49:11,719 --> 00:49:15,759
Speaker 1: health care? Professor Charles Silver of the University of Texas

802
00:49:16,000 --> 00:49:16,600
Speaker 1: School of Law.

803
00:49:16,640 --> 00:49:19,600
Speaker 2: Thank you, sir, Thank you, Michael Pleasure.

804
00:49:19,840 --> 00:49:23,520
Speaker 1: And with that, might I suggest to each and every

805
00:49:23,560 --> 00:49:27,480
Speaker 1: one of you that while politics is an interesting undertaking,

806
00:49:27,640 --> 00:49:31,279
Speaker 1: and it is you know, winning elections, and he said this,

807
00:49:31,360 --> 00:49:34,120
Speaker 1: and we're going to show him, and you know, it's

808
00:49:34,160 --> 00:49:37,600
Speaker 1: a battle royale. And you know I argued with my

809
00:49:37,719 --> 00:49:42,719
Speaker 1: cousin at the Thanksgiving table. At the end of it all,

810
00:49:43,520 --> 00:49:49,800
Speaker 1: the reason for the arguments, reason for the elections should

811
00:49:49,920 --> 00:49:58,400
Speaker 1: be very redemptive, very practical, not just existential, not just ideological.

812
00:49:58,480 --> 00:50:04,279
Speaker 1: They're real to your life, and that is creating a

813
00:50:04,320 --> 00:50:11,719
Speaker 1: governmental system where individuals are free to thrive. Government is

814
00:50:11,800 --> 00:50:16,879
Speaker 1: not just. Government is not merciful. Government is not protective.

815
00:50:17,000 --> 00:50:24,040
Speaker 1: It is not good. Government is clunky, it's inefficient. If

816
00:50:24,080 --> 00:50:26,359
Speaker 1: you've stood in line at the DPS office to get

817
00:50:26,400 --> 00:50:29,040
Speaker 1: your driver's license and thought to yourself, you could move

818
00:50:29,040 --> 00:50:33,239
Speaker 1: this thing along. If you've seen someone who is on

819
00:50:33,400 --> 00:50:37,760
Speaker 1: the clock and doesn't care about results. If you've seen

820
00:50:37,840 --> 00:50:40,719
Speaker 1: the worst of government in every aspect, whether it's the

821
00:50:40,760 --> 00:50:43,680
Speaker 1: inspector who doesn't seem to care that they're coming back

822
00:50:43,719 --> 00:50:46,759
Speaker 1: and adding these regulations that are going to cost this

823
00:50:46,880 --> 00:50:48,399
Speaker 1: much more for you to build this, and now you're

824
00:50:48,400 --> 00:50:50,600
Speaker 1: going to walk away from the project and lead the

825
00:50:50,600 --> 00:50:54,120
Speaker 1: property vacant, and that's not good for anybody. These are

826
00:50:54,160 --> 00:50:56,960
Speaker 1: the things that we should spend our time with. And

827
00:50:57,400 --> 00:51:01,839
Speaker 1: I say this because politics has become sport and it's

828
00:51:01,880 --> 00:51:04,880
Speaker 1: become for many people their favorite hobby. But let's not

829
00:51:05,000 --> 00:51:07,160
Speaker 1: lose track of what we're trying to do here, which

830
00:51:07,200 --> 00:51:11,640
Speaker 1: is literal, not to exaggerate, save our country. And gentleman

831
00:51:11,800 --> 00:51:13,000
Speaker 1: Elus has left.

832
00:51:13,600 --> 00:51:15,759
Speaker 2: Nay, thank you and good night.

833
00:51:17,120 --> 00:51:20,120
Speaker 1: If you like the Michael Berry Show and podcast, please

834
00:51:20,360 --> 00:51:24,480
Speaker 1: tell one friend And if you're so inclined write a

835
00:51:24,600 --> 00:51:29,640
Speaker 1: nice review of our podcast. Comments, suggestions, questions, and interest

836
00:51:29,760 --> 00:51:33,600
Speaker 1: in being a corporate sponsor and partner can be communicated

837
00:51:33,640 --> 00:51:38,120
Speaker 1: directly to the show at our email address, Michael at

838
00:51:38,280 --> 00:51:42,719
Speaker 1: Michael Berryshow dot com, or simply by clicking on our website,

839
00:51:43,120 --> 00:51:47,640
Speaker 1: Michael Berryshow dot com. The Michael Berry Show and Podcast

840
00:51:47,920 --> 00:51:53,040
Speaker 1: is produced by Ramon Roeblis, the King of Ding. Executive

841
00:51:53,120 --> 00:52:01,960
Speaker 1: producer is Chad Knakanishi. Jim mud is the creative director.

842
00:52:02,760 --> 00:52:08,360
Speaker 1: Voices Jingles, Tomfoolery and Shenanigans are provided by Chance McLean.

843
00:52:09,160 --> 00:52:13,640
Speaker 1: Director of Research is Sandy Peterson. Emily Bull is our

844
00:52:13,680 --> 00:52:21,120
Speaker 1: assistant listener and superfan. Contributions are appreciated and often incorporated

845
00:52:21,320 --> 00:52:24,880
Speaker 1: into our production. Where possible, we give credit, where not,

846
00:52:25,440 --> 00:52:28,600
Speaker 1: we take all the credit for ourselves. God bless the

847
00:52:28,640 --> 00:52:34,320
Speaker 1: memory of Rush Limbaugh. Long live Elvis, be a simple

848
00:52:34,360 --> 00:52:40,200
Speaker 1: man like Leonard Skinnard told you, and God bless America. Finally,

849
00:52:40,920 --> 00:52:44,680
Speaker 1: if you know a veteran suffering from PTSD, call Camp

850
00:52:44,719 --> 00:52:50,600
Speaker 1: Hope at eight seven seven seven one seven PTSD and

851
00:52:50,680 --> 00:52:55,040
Speaker 1: a combat veteran will answer the phone to provide free counseling.