1 00:00:04,080 --> 00:00:10,040 Speaker 1: It's that time time, time, time, Luck and Load. 2 00:00:11,680 --> 00:00:25,279 Speaker 2: Michael Verie Show is on the air. Professor Charles Silver 3 00:00:25,480 --> 00:00:25,919 Speaker 2: is our guest. 4 00:00:25,960 --> 00:00:29,440 Speaker 3: He's a professor at the University of Texas School of Law, 5 00:00:29,480 --> 00:00:31,800 Speaker 3: which I happen to believe is fantastic because I'm a 6 00:00:31,840 --> 00:00:38,000 Speaker 3: graduate of Saye, his book is Overcharged, Why Americans pay 7 00:00:38,080 --> 00:00:42,400 Speaker 3: too much for healthcare? You mentioned that the problem began 8 00:00:42,960 --> 00:00:46,920 Speaker 3: with Medicare Medicaid in the sixties, part of Lyndon Johnson's 9 00:00:47,120 --> 00:00:50,239 Speaker 3: Great Society, which turned out not to be. It was 10 00:00:50,320 --> 00:00:56,320 Speaker 3: two point zero of FDRs taking over of the American 11 00:00:56,440 --> 00:00:59,480 Speaker 3: economy and it's hard to strip that back out of 12 00:00:59,520 --> 00:01:04,040 Speaker 3: life when Medicare got involved. So my dad's eighty four, 13 00:01:04,160 --> 00:01:06,839 Speaker 3: my mom recently passed, and I go in and review 14 00:01:06,880 --> 00:01:09,800 Speaker 3: every expense, everything that comes in and all that this 15 00:01:09,880 --> 00:01:14,240 Speaker 3: whole Medicare thing. I have a show sponsor called Senior 16 00:01:14,240 --> 00:01:18,800 Speaker 3: Health Services dot Com, and he and his team help 17 00:01:19,000 --> 00:01:22,560 Speaker 3: people who are trying to navigate Medicare. And every day 18 00:01:22,600 --> 00:01:24,319 Speaker 3: I get someone who emails me and says, can you 19 00:01:24,360 --> 00:01:27,040 Speaker 3: connect me with them? And I forward it and sometimes 20 00:01:27,040 --> 00:01:29,080 Speaker 3: I stay involved for a little while just to see, 21 00:01:29,120 --> 00:01:32,240 Speaker 3: you know, kind of what they're working through. It's amazing 22 00:01:32,280 --> 00:01:33,880 Speaker 3: to people that, all of a sudden, I guess, when 23 00:01:33,880 --> 00:01:36,880 Speaker 3: you turn sixty five, you're getting robocalls and junk mail 24 00:01:36,880 --> 00:01:38,840 Speaker 3: and all this Medicare, Medicare, Medicare. 25 00:01:38,640 --> 00:01:40,080 Speaker 4: And people had no idea. 26 00:01:40,240 --> 00:01:44,040 Speaker 3: Now, all of a sudden, I've been, you know, dumped 27 00:01:44,360 --> 00:01:48,880 Speaker 3: into the Medicare playground, and I don't know why, how 28 00:01:48,920 --> 00:01:50,000 Speaker 3: does this even work? 29 00:01:52,120 --> 00:01:52,760 Speaker 1: Too well? 30 00:01:53,680 --> 00:01:58,160 Speaker 5: I just I recently hit that age myself, so I 31 00:01:58,200 --> 00:02:00,880 Speaker 5: can sympathize with those who's mail by are crammed with 32 00:02:00,920 --> 00:02:04,480 Speaker 5: Medicare advantage flyers and things of that sort. I'm sick 33 00:02:04,520 --> 00:02:07,760 Speaker 5: of seeing them. And I'm not even using Medicare. I'm 34 00:02:07,800 --> 00:02:11,480 Speaker 5: still working, so I'm staying on my employer's healthcare system 35 00:02:11,720 --> 00:02:16,200 Speaker 5: or healthcare insurance, although that is very expensive and far 36 00:02:16,280 --> 00:02:20,520 Speaker 5: too comprehensive. You know, it's because of the mandates regarding 37 00:02:21,080 --> 00:02:25,360 Speaker 5: what employer sponsored coverage has to conclude that I wind 38 00:02:25,480 --> 00:02:28,799 Speaker 5: up paying, you know, way too much. Everybody does pay 39 00:02:29,000 --> 00:02:33,880 Speaker 5: way too much for insurance. But you know, Medicare, what 40 00:02:33,919 --> 00:02:36,400 Speaker 5: can I say? It's a program that was designed to 41 00:02:36,440 --> 00:02:41,800 Speaker 5: succeed by massively inflating the deficit. You know, everybody thinks 42 00:02:41,880 --> 00:02:45,520 Speaker 5: that Medicare is something that you earn over the course 43 00:02:45,560 --> 00:02:47,639 Speaker 5: of your lifetime. We don't think of it as welfare, 44 00:02:47,680 --> 00:02:51,600 Speaker 5: and politicians who refer to it as welfare are excoriated. 45 00:02:52,240 --> 00:02:56,440 Speaker 5: But the amount that people pay into Medicare is way, way, 46 00:02:56,480 --> 00:02:59,480 Speaker 5: way smaller than the amount that they get out for 47 00:02:59,639 --> 00:03:03,560 Speaker 5: most people. Now they're obviously exceptions to that, but for 48 00:03:03,680 --> 00:03:07,880 Speaker 5: most people, the way that the program succeeds is by 49 00:03:07,960 --> 00:03:11,919 Speaker 5: charging them less than the benefits that they will get 50 00:03:12,040 --> 00:03:13,200 Speaker 5: out of the system. 51 00:03:13,600 --> 00:03:14,920 Speaker 6: Well, you know, that's a nice arrangement. 52 00:03:14,960 --> 00:03:18,240 Speaker 5: I'd like to have that, But the problem is somebody. 53 00:03:18,280 --> 00:03:20,240 Speaker 5: The money to pay for all those benefits has to 54 00:03:20,280 --> 00:03:22,720 Speaker 5: come from somewhere, and it. 55 00:03:22,840 --> 00:03:25,120 Speaker 1: Only only two sources. One is general. 56 00:03:24,840 --> 00:03:28,680 Speaker 5: Tax revenue, so they use money in addition tax revenue 57 00:03:28,720 --> 00:03:32,720 Speaker 5: in addition to the employee tax to fund the program. 58 00:03:32,720 --> 00:03:36,680 Speaker 5: And the other is deficit spending. And every one of 59 00:03:36,720 --> 00:03:41,800 Speaker 5: these expansions of the Medicare program is funded through the deficit. 60 00:03:42,000 --> 00:03:46,080 Speaker 5: So you know, back when Bush two was president, right 61 00:03:46,080 --> 00:03:51,480 Speaker 5: he created Medicare part D, the Prescription Drug Benefit Program. Well, 62 00:03:51,520 --> 00:03:54,760 Speaker 5: the premiums, even initially for that program were only set 63 00:03:54,760 --> 00:03:58,240 Speaker 5: at fifty percent of the estimated cost. Now they're down 64 00:03:58,280 --> 00:04:01,800 Speaker 5: to twenty five percent of the estimated cost, which means 65 00:04:01,840 --> 00:04:05,400 Speaker 5: everybody loves Medicare party because it's a great deal. Right, 66 00:04:05,440 --> 00:04:08,000 Speaker 5: I'm only paying twenty five percent of the cost. But 67 00:04:08,760 --> 00:04:11,640 Speaker 5: what you're really doing is taking the cost of prescription 68 00:04:11,760 --> 00:04:15,600 Speaker 5: drugs and rolling them into the deficit. And the same 69 00:04:15,640 --> 00:04:19,640 Speaker 5: thing goes for Obamacare with all these premium subsidies. Everything 70 00:04:19,760 --> 00:04:22,920 Speaker 5: that the government does is designed to be popular by 71 00:04:23,040 --> 00:04:25,920 Speaker 5: being priced below. 72 00:04:25,720 --> 00:04:28,719 Speaker 1: Its actual cost, and the. 73 00:04:28,000 --> 00:04:30,479 Speaker 5: Result of that in the long run has to be 74 00:04:31,120 --> 00:04:35,360 Speaker 5: deficit increases and inflation increases. 75 00:04:35,400 --> 00:04:37,039 Speaker 1: There's just no getting around that. 76 00:04:37,960 --> 00:04:42,760 Speaker 3: It's frustrating because then Medicare, the government is telling you 77 00:04:42,800 --> 00:04:44,800 Speaker 3: which doctors you can go to and which you can't, 78 00:04:44,800 --> 00:04:47,440 Speaker 3: which procedures you can do in which you can't, and 79 00:04:47,480 --> 00:04:50,600 Speaker 3: so you know, and look, it sounds like you and 80 00:04:50,600 --> 00:04:54,760 Speaker 3: I are relatively aligned. I was an acolyte of Professor 81 00:04:54,800 --> 00:04:57,920 Speaker 3: Leino Graia, so you can probably understand where my views 82 00:04:57,960 --> 00:04:59,880 Speaker 3: are with regard to politics and the role of the 83 00:05:00,040 --> 00:05:04,880 Speaker 3: government and the individual. I'm probably more libertarian certainly than 84 00:05:04,920 --> 00:05:07,559 Speaker 3: he was. I'm over on the Rand and Ron Paul 85 00:05:08,040 --> 00:05:12,000 Speaker 3: end of things. But what I find frustrating is that 86 00:05:12,120 --> 00:05:16,599 Speaker 3: people seem to think that somehow government is protecting you 87 00:05:17,320 --> 00:05:22,080 Speaker 3: and aiding you. But in fact, what goes with that is, 88 00:05:22,160 --> 00:05:24,640 Speaker 3: you know why you don't feed the bears at the zoo, 89 00:05:25,040 --> 00:05:28,400 Speaker 3: is they're controlling you, and any government powerful enough to 90 00:05:28,400 --> 00:05:31,760 Speaker 3: pay for your medical surgery or medical procedures, powerful enough 91 00:05:31,760 --> 00:05:34,560 Speaker 3: to take it away, and then they start making decisions 92 00:05:34,600 --> 00:05:37,400 Speaker 3: for you. And that's where we get into the civil liberties. 93 00:05:37,440 --> 00:05:40,880 Speaker 3: And that's where I get very frustrated, because we've now 94 00:05:40,920 --> 00:05:44,480 Speaker 3: moved beyond healthcare and we've moved into a sort of 95 00:05:44,520 --> 00:05:48,560 Speaker 3: totalitarian authoritarian control of the individual. 96 00:05:49,360 --> 00:05:53,160 Speaker 5: Well, you're certainly singing my song because you know you're 97 00:05:53,200 --> 00:05:56,760 Speaker 5: a libertarian. I'm an adjunct scholar at the Cato Institute. 98 00:05:56,760 --> 00:05:57,880 Speaker 1: I don't think it gets much. 99 00:05:57,720 --> 00:06:02,640 Speaker 5: More libertarian than that, I would say, so, so we're 100 00:06:02,680 --> 00:06:07,359 Speaker 5: on the same page as far as, you know, being 101 00:06:07,480 --> 00:06:12,720 Speaker 5: very very concerned about the governmental control. I think that 102 00:06:13,720 --> 00:06:17,000 Speaker 5: governmental control is part of the story, but I think 103 00:06:17,040 --> 00:06:22,120 Speaker 5: governmental ineptitude is probably a much bigger part of the story. 104 00:06:23,600 --> 00:06:26,039 Speaker 5: You know, I'm willing to say, oh, some of those 105 00:06:26,200 --> 00:06:29,400 Speaker 5: you know, bureaucrats who run these programs actually want to 106 00:06:29,520 --> 00:06:32,240 Speaker 5: want to help people, and may even believe they are 107 00:06:32,320 --> 00:06:37,840 Speaker 5: helping people. But it's actually very difficult to run the 108 00:06:37,880 --> 00:06:42,200 Speaker 5: healthcare system. Well, that's why market forces are so important, 109 00:06:42,279 --> 00:06:48,200 Speaker 5: because market forces are constantly rewarding providers for figuring out 110 00:06:48,680 --> 00:06:50,440 Speaker 5: how to serve patients better. 111 00:06:50,680 --> 00:06:53,000 Speaker 1: Right, that's how you can get business. If you can. 112 00:06:52,839 --> 00:06:55,840 Speaker 5: Figure out how to serve your customers better, then you'll 113 00:06:55,880 --> 00:07:00,400 Speaker 5: get more customers. And that's just something that requires wires 114 00:07:00,839 --> 00:07:03,880 Speaker 5: people who know that nuts and bolts really well, to 115 00:07:03,960 --> 00:07:07,640 Speaker 5: be constantly reflecting on how they're doing their jobs. 116 00:07:07,800 --> 00:07:08,000 Speaker 1: Right. 117 00:07:08,960 --> 00:07:11,880 Speaker 5: The government bureaucrats, they don't do that. They don't even 118 00:07:11,920 --> 00:07:15,640 Speaker 5: know how the jobs work. They just exist mainly to 119 00:07:15,680 --> 00:07:21,200 Speaker 5: pay bills and to enact regulations that enable them to 120 00:07:21,960 --> 00:07:24,480 Speaker 5: deal with the burden that all this imposes on the 121 00:07:24,480 --> 00:07:28,480 Speaker 5: federal government. And the results for consumers are just terrible. 122 00:07:28,680 --> 00:07:31,440 Speaker 5: You know, all these problems that everybody complains about, prior 123 00:07:31,520 --> 00:07:37,400 Speaker 5: authorization requirements, surprise bills, these things called facility fees that you. 124 00:07:37,360 --> 00:07:39,200 Speaker 1: Know, you go to an emergency room. 125 00:07:39,000 --> 00:07:41,320 Speaker 5: The doctor says, oh, you've got a fever, take some 126 00:07:41,360 --> 00:07:43,400 Speaker 5: aster and go home, and then you get a build 127 00:07:43,400 --> 00:07:46,200 Speaker 5: for ten thousand dollars because you literally because you. 128 00:07:46,320 --> 00:07:47,640 Speaker 1: Walked in the front doors. 129 00:07:47,680 --> 00:07:50,920 Speaker 5: It's just like a cover charge at a bar or 130 00:07:50,920 --> 00:07:54,920 Speaker 5: something like that, except a lot bigger. You know, none 131 00:07:54,920 --> 00:07:59,240 Speaker 5: of that stuff exists in the direct payment system. It 132 00:07:59,320 --> 00:08:04,720 Speaker 5: all exists because the government regulates the way healthcare is. 133 00:08:04,600 --> 00:08:07,080 Speaker 1: Delivered, and it does it in stupid. 134 00:08:06,680 --> 00:08:10,120 Speaker 5: Ways because it's hard to do it right. 135 00:08:10,320 --> 00:08:13,800 Speaker 3: And government's not in the business of efficiency. Professor Charles 136 00:08:13,840 --> 00:08:17,480 Speaker 3: Silver is our guest. The book is Overcharged, Why you 137 00:08:17,960 --> 00:08:20,200 Speaker 3: Americans pay too much for healthcare? 138 00:08:22,480 --> 00:08:25,520 Speaker 1: And the Michael Berry Show good not. 139 00:08:29,240 --> 00:08:32,440 Speaker 3: Professor Charles Silver of the University of Texas School of 140 00:08:32,520 --> 00:08:36,839 Speaker 3: Law is our guest. He was I have come to 141 00:08:36,920 --> 00:08:40,000 Speaker 3: learn in the course of our conversation at ut Law 142 00:08:40,920 --> 00:08:43,120 Speaker 3: almost ten years before I was there, and still is. 143 00:08:43,559 --> 00:08:46,440 Speaker 3: I did not know him, but I happened to think 144 00:08:46,480 --> 00:08:49,240 Speaker 3: the world of that law school, and I gained a 145 00:08:49,280 --> 00:08:55,520 Speaker 3: lot from being there, both associations and education. And this 146 00:08:55,600 --> 00:08:59,120 Speaker 3: book has been highly recommended to me by numerous folks 147 00:08:59,720 --> 00:09:01,960 Speaker 3: as to how to gain a better understanding of why 148 00:09:01,960 --> 00:09:07,400 Speaker 3: the healthcare system costs you so much. Overcharged, Why Americans 149 00:09:07,440 --> 00:09:12,240 Speaker 3: pay too much for healthcare? Professor Charles Silver is our guest. Professor, 150 00:09:12,440 --> 00:09:18,360 Speaker 3: let's talk about young people. By young I'm fifty three, 151 00:09:18,400 --> 00:09:21,040 Speaker 3: so I'm gonna throw myself into there. You know, I've 152 00:09:21,080 --> 00:09:24,280 Speaker 3: read that something like half the healthcare costs in this 153 00:09:24,400 --> 00:09:27,840 Speaker 3: country are expended on people within the last two years 154 00:09:27,840 --> 00:09:29,559 Speaker 3: of their lives. And you know, we see this where 155 00:09:29,559 --> 00:09:32,160 Speaker 3: it's just constant. It's just one thing after another after another, 156 00:09:32,200 --> 00:09:34,120 Speaker 3: and then they pass and then you kick in the 157 00:09:34,120 --> 00:09:36,840 Speaker 3: funeral industry, and I mean it's these are all industries, 158 00:09:36,920 --> 00:09:40,760 Speaker 3: like the bridal industry and the birthing industry. When you 159 00:09:40,840 --> 00:09:44,600 Speaker 3: look at a person who is relatively healthy without a 160 00:09:44,720 --> 00:09:50,240 Speaker 3: chronic condition, and you're looking at the cost to them 161 00:09:50,400 --> 00:09:55,160 Speaker 3: that they're bearing, which really is the risk you're willing 162 00:09:55,240 --> 00:09:57,800 Speaker 3: to assume. Right, if you're never going to need a doctor, 163 00:09:58,160 --> 00:10:01,040 Speaker 3: then you don't need insurance. We just don't know which 164 00:10:01,040 --> 00:10:02,320 Speaker 3: one of us is going to be in a car 165 00:10:02,360 --> 00:10:05,040 Speaker 3: wreck or have a heart attack. So we're trying the 166 00:10:05,160 --> 00:10:07,800 Speaker 3: same way we leverage the risk on if our house 167 00:10:07,840 --> 00:10:11,319 Speaker 3: burns down. We're trying to kind of to keep that 168 00:10:11,360 --> 00:10:15,320 Speaker 3: at bay and to make a good financial decision. Where 169 00:10:15,440 --> 00:10:18,600 Speaker 3: is that going wrong today? Because my guess is most 170 00:10:18,640 --> 00:10:22,920 Speaker 3: people are overpaying for insurance coverage that they won't need 171 00:10:23,040 --> 00:10:26,200 Speaker 3: until much later. That's going toward people at their end 172 00:10:26,200 --> 00:10:31,280 Speaker 3: of life. Oh, I agree that I think that story 173 00:10:31,400 --> 00:10:34,400 Speaker 3: is right. There are a bunch of thoughts that it prompts. 174 00:10:34,440 --> 00:10:36,280 Speaker 5: One of them is, you know, I've never been a 175 00:10:36,280 --> 00:10:42,160 Speaker 5: fan of taxing people who are relatively young to provide 176 00:10:42,320 --> 00:10:45,160 Speaker 5: benefits to people who are relatively old. That strikes me 177 00:10:45,280 --> 00:10:47,120 Speaker 5: is wrong on a variety of levels. 178 00:10:47,200 --> 00:10:47,400 Speaker 1: You know. 179 00:10:47,480 --> 00:10:51,640 Speaker 5: One is, every moral theory that I know of says 180 00:10:51,679 --> 00:10:56,200 Speaker 5: you move money from richer people to poorer people. Well, 181 00:10:56,480 --> 00:11:01,320 Speaker 5: older people are wealthier than younger people. Be surprising to anybody. 182 00:11:01,360 --> 00:11:03,600 Speaker 5: They've had their whole lives to work right and save. 183 00:11:03,720 --> 00:11:06,040 Speaker 5: They've paid off their cars, they've paid off their homes. 184 00:11:06,080 --> 00:11:09,560 Speaker 5: You know, they have other assets. Right, They're on average, 185 00:11:09,720 --> 00:11:12,480 Speaker 5: much wealthier than younger people who are struggling, you know, 186 00:11:12,600 --> 00:11:16,000 Speaker 5: raising families, you know, just getting jobs. 187 00:11:15,880 --> 00:11:18,440 Speaker 1: Dealing with college debt and all that stuff. 188 00:11:18,480 --> 00:11:20,839 Speaker 5: So my moral view is if we were going to 189 00:11:20,880 --> 00:11:23,040 Speaker 5: move money in any direction, we should move it from 190 00:11:23,080 --> 00:11:26,360 Speaker 5: older people to younger people. But our system does the reverse. 191 00:11:26,400 --> 00:11:28,520 Speaker 5: We're robbing the poor to pay the rich. I don't 192 00:11:28,600 --> 00:11:39,520 Speaker 5: understand that. Another thing is, excuse me, the system really 193 00:11:40,000 --> 00:11:46,760 Speaker 5: disserves people because it eliminates all caps on spending. 194 00:11:46,800 --> 00:11:47,600 Speaker 1: You were talking about. 195 00:11:47,480 --> 00:11:49,920 Speaker 5: End of life care and how we spend so much 196 00:11:50,000 --> 00:11:52,280 Speaker 5: money in the last year or two of people's lives. 197 00:11:52,320 --> 00:11:54,280 Speaker 1: Well, if people had. 198 00:11:54,120 --> 00:11:57,400 Speaker 5: To spend their own money, nobody would spend an infinite 199 00:11:57,400 --> 00:12:01,320 Speaker 5: amount in their last two years healthcare. They would have 200 00:12:01,360 --> 00:12:04,320 Speaker 5: to make hard decisions, right, These are not pleasant decisions, 201 00:12:04,760 --> 00:12:08,760 Speaker 5: but they would make decisions about how much healthcare they want. 202 00:12:08,880 --> 00:12:11,520 Speaker 5: Is it worth spending a million dollars to extend my 203 00:12:11,679 --> 00:12:14,680 Speaker 5: life by a month, Right, that's the kind of decision 204 00:12:14,679 --> 00:12:18,240 Speaker 5: they would have to make. Well, today, because we've removed 205 00:12:18,280 --> 00:12:23,120 Speaker 5: all caps from the system, nobody has to make those decisions. Instead, 206 00:12:23,160 --> 00:12:26,760 Speaker 5: we just spend literally an infinite amount of money on 207 00:12:26,920 --> 00:12:30,040 Speaker 5: people who are in the final stages of their illness. 208 00:12:30,160 --> 00:12:33,000 Speaker 1: We get no bang for the buck. You know, we have. 209 00:12:33,000 --> 00:12:36,559 Speaker 5: People, literally we have people who are receiving cancer treatments, 210 00:12:36,760 --> 00:12:40,640 Speaker 5: new cancer treatments that cost a million dollars, and all 211 00:12:40,679 --> 00:12:43,640 Speaker 5: those treatments do is extend their lives by about a month. 212 00:12:44,160 --> 00:12:46,960 Speaker 5: And it's not even a good month. It's not a 213 00:12:47,000 --> 00:12:48,520 Speaker 5: month when you're going to be out there on the 214 00:12:48,559 --> 00:12:52,040 Speaker 5: golf course, playing with your buddies and drinking beer. It's 215 00:12:52,080 --> 00:12:55,120 Speaker 5: a month like you're in the hospital right for the 216 00:12:55,160 --> 00:12:55,720 Speaker 5: whole month. 217 00:12:56,880 --> 00:12:58,240 Speaker 6: These things just make no sense. 218 00:12:58,400 --> 00:13:03,320 Speaker 5: Right, But the government cannot make those decisions, literally, it 219 00:13:03,440 --> 00:13:08,320 Speaker 5: cannot because the moment the government starts talking about rationing care, 220 00:13:08,600 --> 00:13:12,080 Speaker 5: everybody loses their minds and you don't want to be 221 00:13:12,160 --> 00:13:18,080 Speaker 5: the politician that they're rallying against. Right, So the government 222 00:13:18,240 --> 00:13:22,240 Speaker 5: simply ignores the need to make these decisions and just 223 00:13:22,280 --> 00:13:25,760 Speaker 5: spends endless amounts of money because it's other people's money. 224 00:13:25,760 --> 00:13:27,160 Speaker 5: So why does the government care? 225 00:13:27,640 --> 00:13:32,240 Speaker 6: Right? And you know, we just have to. 226 00:13:32,120 --> 00:13:36,480 Speaker 5: Come back to the world in which people are responsible 227 00:13:36,520 --> 00:13:41,480 Speaker 5: for their own end of life care. You know, it's 228 00:13:41,520 --> 00:13:43,840 Speaker 5: a sad thing, but it's true. We will all die 229 00:13:43,880 --> 00:13:47,480 Speaker 5: at some point, and the fact that we will all 230 00:13:47,559 --> 00:13:50,960 Speaker 5: die at some point affects a thousand. 231 00:13:50,559 --> 00:13:52,600 Speaker 6: Decisions that each of us makes. 232 00:13:52,679 --> 00:13:56,199 Speaker 5: Right, When am I going to stop working? Well, if 233 00:13:56,240 --> 00:13:58,160 Speaker 5: I'm thinking I don't have much longer to live, it 234 00:13:58,240 --> 00:14:00,640 Speaker 5: probably will stop working so I can stand my last 235 00:14:00,679 --> 00:14:03,160 Speaker 5: you know, a couple of years with my family or 236 00:14:03,200 --> 00:14:05,680 Speaker 5: traveling or whatever it is, right, I mean, if you 237 00:14:05,720 --> 00:14:08,559 Speaker 5: start to think about it, knowing that at some point 238 00:14:08,559 --> 00:14:13,079 Speaker 5: we will all die, it affects, as I said, thousands 239 00:14:13,160 --> 00:14:16,000 Speaker 5: of decisions that we make you know, do I want 240 00:14:16,000 --> 00:14:18,160 Speaker 5: to live in this house that I'm in now until 241 00:14:18,200 --> 00:14:19,560 Speaker 5: the end of my life, or do I want to 242 00:14:19,600 --> 00:14:23,040 Speaker 5: move to a house that's more handicap equipped and things 243 00:14:23,040 --> 00:14:26,760 Speaker 5: of that sort. Right, this is just another decision. It's 244 00:14:26,760 --> 00:14:29,560 Speaker 5: a tough decision. I'm not trying to say otherwise, but 245 00:14:29,640 --> 00:14:31,280 Speaker 5: it's a decision that needs. 246 00:14:31,040 --> 00:14:33,480 Speaker 1: To be made, and it needs to be made not. 247 00:14:33,480 --> 00:14:36,440 Speaker 5: By the government, but by the people who are directly 248 00:14:36,600 --> 00:14:40,800 Speaker 5: involved and who can think hard about all these tough problems. 249 00:14:40,800 --> 00:14:43,240 Speaker 5: There's no way the government's going to make a good decision. 250 00:14:43,560 --> 00:14:47,360 Speaker 5: Their incentives are wrong, their knowledge is too limited, they 251 00:14:47,360 --> 00:14:50,560 Speaker 5: don't have access to the counselors that individuals will talk 252 00:14:50,600 --> 00:14:51,720 Speaker 5: to and making these. 253 00:14:51,600 --> 00:14:52,600 Speaker 1: Kinds of decisions. 254 00:14:53,240 --> 00:14:54,560 Speaker 6: So, you know, we just have. 255 00:14:54,560 --> 00:14:57,720 Speaker 5: To get the government out of this business. What I 256 00:14:57,760 --> 00:14:59,120 Speaker 5: have proposed is. 257 00:15:01,000 --> 00:15:01,400 Speaker 1: That we can. 258 00:15:01,520 --> 00:15:03,400 Speaker 5: You know, there is one other problem though that we 259 00:15:03,440 --> 00:15:05,920 Speaker 5: haven't discussed, which we do need to discuss, which is 260 00:15:05,960 --> 00:15:09,040 Speaker 5: there are some people who are too poor to afford 261 00:15:09,600 --> 00:15:12,880 Speaker 5: fundamental health care. We do need to come up with 262 00:15:12,920 --> 00:15:15,440 Speaker 5: a way of dealing with those people, because when they 263 00:15:15,440 --> 00:15:18,680 Speaker 5: show up at the hospital needing healthcare, they're not going 264 00:15:18,720 --> 00:15:21,000 Speaker 5: to be turned away. Right now, We're not going to 265 00:15:21,000 --> 00:15:23,640 Speaker 5: be having sick people dying in the streets because they 266 00:15:23,680 --> 00:15:26,920 Speaker 5: can't afford healthcare. So we need to come up with 267 00:15:26,960 --> 00:15:29,360 Speaker 5: a way to deal with that. But the obvious way 268 00:15:29,400 --> 00:15:31,600 Speaker 5: to deal with that is through a negative income text, 269 00:15:31,880 --> 00:15:34,720 Speaker 5: the sort of thing that Milton Friedman proposed. You know, 270 00:15:34,800 --> 00:15:39,200 Speaker 5: you provide everybody with a kind of amount of sustenance 271 00:15:39,280 --> 00:15:41,240 Speaker 5: that they can use for this purpose. You could put 272 00:15:41,280 --> 00:15:45,160 Speaker 5: it into a restricted medical account if you wanted, But 273 00:15:45,200 --> 00:15:47,520 Speaker 5: the idea is once you give it to them, it's 274 00:15:47,600 --> 00:15:49,920 Speaker 5: hands off for the rest of it. The government doesn't 275 00:15:49,920 --> 00:15:51,800 Speaker 5: get involved in the delivery of healthcare. 276 00:15:52,800 --> 00:15:54,000 Speaker 1: It just people make. 277 00:15:53,880 --> 00:15:58,200 Speaker 5: Decisions on themselves with their own money, and life goes forward. 278 00:15:58,240 --> 00:16:00,360 Speaker 5: And I think if we did that, the healthcare system 279 00:16:00,400 --> 00:16:02,800 Speaker 5: would operate much more efficiently. 280 00:16:03,120 --> 00:16:07,880 Speaker 3: Well, the great frustration, as you know, is that everybody 281 00:16:07,880 --> 00:16:10,600 Speaker 3: gets a vote, even people that make bad decisions, and 282 00:16:10,640 --> 00:16:13,840 Speaker 3: that many people make bad decisions. You know that we 283 00:16:13,880 --> 00:16:15,800 Speaker 3: will have a lot of people who say I can't 284 00:16:15,840 --> 00:16:19,120 Speaker 3: afford medical care because they don't save money. But they've 285 00:16:19,160 --> 00:16:22,440 Speaker 3: got a big screen TV in every room, and they've got, 286 00:16:22,760 --> 00:16:25,200 Speaker 3: you know, a car they can't afford that they're driving. 287 00:16:26,120 --> 00:16:27,760 Speaker 4: They end up with the car that they can't afford, 288 00:16:27,840 --> 00:16:29,119 Speaker 4: and we end up paying. 289 00:16:28,880 --> 00:16:31,400 Speaker 3: For the healthcare that they can't afford to The book 290 00:16:31,440 --> 00:16:35,160 Speaker 3: is Overcharged, Why Americans Pay Too Much for Healthcare? 291 00:16:35,200 --> 00:16:37,240 Speaker 4: Professor Charles Silver, And. 292 00:16:37,320 --> 00:16:38,880 Speaker 1: Everybody knows who this guy is. 293 00:16:38,920 --> 00:16:45,240 Speaker 3: Come on, man with the Michael Barrier, Come on, Professor 294 00:16:45,320 --> 00:16:47,840 Speaker 3: Charles Silver is our guest. It's a subject of great 295 00:16:47,880 --> 00:16:49,320 Speaker 3: interest to me and too many of you. 296 00:16:50,280 --> 00:16:50,920 Speaker 4: The book is. 297 00:16:50,920 --> 00:16:56,080 Speaker 3: Called Overcharged, Why Americans Pay Too Much for Healthcare? He 298 00:16:56,280 --> 00:17:00,120 Speaker 3: is a law professor at the University of Texas at 299 00:17:00,160 --> 00:17:04,359 Speaker 3: Austin School of Law. And we ended the last segment 300 00:17:04,480 --> 00:17:06,920 Speaker 3: with the discussion that at the end of the day, 301 00:17:07,560 --> 00:17:11,240 Speaker 3: the allocation of scarce resources and who will make that decision. 302 00:17:12,040 --> 00:17:16,800 Speaker 3: We're back at that point again in every family. You know, 303 00:17:16,840 --> 00:17:21,440 Speaker 3: you got eight kids and you've got one chicken. Mom 304 00:17:21,520 --> 00:17:23,880 Speaker 3: says you're not getting a second piece. So there's some 305 00:17:23,920 --> 00:17:28,760 Speaker 3: cartilage left on that leg. If you're hungry, you'll eat that. 306 00:17:29,440 --> 00:17:32,240 Speaker 3: And there comes a point where we have to decide 307 00:17:33,000 --> 00:17:36,720 Speaker 3: with scarce resources, who will make the decision as to 308 00:17:36,760 --> 00:17:38,840 Speaker 3: where those resources will be deployed. 309 00:17:39,240 --> 00:17:42,359 Speaker 4: Will it be the government or will it be the individual? 310 00:17:42,720 --> 00:17:46,760 Speaker 3: And if it's the individual, there will be those who say, well, 311 00:17:47,119 --> 00:17:49,760 Speaker 3: I want as much as my neighbor has, Okay, we'll 312 00:17:49,760 --> 00:17:53,680 Speaker 3: earn the money to purchase that. Well, I don't earn 313 00:17:53,880 --> 00:17:56,239 Speaker 3: as much. I want to use the power of the 314 00:17:56,280 --> 00:17:58,960 Speaker 3: gun through at the direction of the government that I 315 00:17:59,000 --> 00:18:00,960 Speaker 3: either more of me than there of the rich people 316 00:18:01,200 --> 00:18:04,760 Speaker 3: I vote for. I want that well. The only alternative 317 00:18:04,800 --> 00:18:07,520 Speaker 3: is for the government to do it. Professor I harkened 318 00:18:07,600 --> 00:18:10,240 Speaker 3: back to a study, and it's been a while since 319 00:18:11,000 --> 00:18:15,320 Speaker 3: I read this book. It's interesting because I'm a believer 320 00:18:15,400 --> 00:18:18,600 Speaker 3: and let the marketplace decide. You know, healthcare is the 321 00:18:18,680 --> 00:18:20,840 Speaker 3: one area where we think everybody gets all the healthcare 322 00:18:20,880 --> 00:18:23,159 Speaker 3: they want, but we all end up paying for that. 323 00:18:23,200 --> 00:18:24,960 Speaker 3: We don't say everybody gets all the food they want, 324 00:18:25,000 --> 00:18:26,720 Speaker 3: or all the cars they want, or all the houses 325 00:18:26,760 --> 00:18:28,520 Speaker 3: they want, or all the clothes they want, but for 326 00:18:28,560 --> 00:18:31,840 Speaker 3: some reason, everybody gets all the healthcare they want, even 327 00:18:31,880 --> 00:18:34,080 Speaker 3: at the point that it's throwing good money after bad. 328 00:18:34,760 --> 00:18:38,960 Speaker 3: So socialist system the opposite of what I propose. In Sweden, 329 00:18:39,480 --> 00:18:42,080 Speaker 3: they did a study, and it was a multi decade 330 00:18:42,119 --> 00:18:44,560 Speaker 3: study you may be aware of it, on prostate cancer 331 00:18:44,640 --> 00:18:50,320 Speaker 3: in men, and they determined that out of I think 332 00:18:50,440 --> 00:18:54,520 Speaker 3: it was three thousand men who had prostate cancer who 333 00:18:54,560 --> 00:18:58,280 Speaker 3: were diagnosed with prostate cancer, and they chose not to 334 00:18:58,359 --> 00:19:02,679 Speaker 3: treat the prostate cancer. And they did about a twenty 335 00:19:02,680 --> 00:19:06,000 Speaker 3: five year study and the number of men who died 336 00:19:06,160 --> 00:19:10,040 Speaker 3: of untreated prostate cancer was something like thirty out of 337 00:19:10,080 --> 00:19:13,800 Speaker 3: three thousand. So they came to the conclusion with a government, 338 00:19:14,040 --> 00:19:18,560 Speaker 3: completely government run system, that with scarce resources, it does 339 00:19:18,600 --> 00:19:23,000 Speaker 3: not make sense for us to treat prostate cancer per 340 00:19:23,080 --> 00:19:25,960 Speaker 3: se because nobody, very few people are going to die 341 00:19:26,000 --> 00:19:29,240 Speaker 3: of prostate cancer. Let's spend our money on other things 342 00:19:29,280 --> 00:19:31,560 Speaker 3: that if we don't spend it there, you die. 343 00:19:32,240 --> 00:19:33,400 Speaker 4: And it strikes me. 344 00:19:33,560 --> 00:19:37,760 Speaker 3: That while that's the opposite of the capitalist system, there 345 00:19:37,800 --> 00:19:41,080 Speaker 3: does need to be an understanding that we're wasting a 346 00:19:41,080 --> 00:19:45,359 Speaker 3: lot of money on studies because and this gets to 347 00:19:45,400 --> 00:19:47,440 Speaker 3: the second point of what you've written a lot about 348 00:19:47,720 --> 00:19:51,160 Speaker 3: medical malpractice and the fear of medical malpractice. 349 00:19:51,240 --> 00:19:52,760 Speaker 4: I don't think everybody. 350 00:19:52,280 --> 00:19:56,560 Speaker 3: Needs a glaucoma test every time they go for their license, 351 00:19:56,600 --> 00:19:59,639 Speaker 3: but god forbid one person not be diagnosed with glaucoma. 352 00:20:00,080 --> 00:20:05,359 Speaker 3: We're practicing defensive medicine. We're over ordering tests, which is 353 00:20:05,359 --> 00:20:07,919 Speaker 3: a waste of our time and energy, but also money, 354 00:20:08,320 --> 00:20:12,359 Speaker 3: and we're not actually doing we're not engaged in what 355 00:20:12,440 --> 00:20:17,480 Speaker 3: I would consider smart effective healing because everyone is afraid 356 00:20:17,760 --> 00:20:18,639 Speaker 3: of being sued. 357 00:20:18,840 --> 00:20:21,000 Speaker 4: And that has we get back to our point. 358 00:20:21,080 --> 00:20:24,240 Speaker 3: The book is overcharged, Why Americans pay too much for healthcare? 359 00:20:24,560 --> 00:20:26,840 Speaker 3: I think that's a big portion of what we spend. 360 00:20:27,040 --> 00:20:30,080 Speaker 3: Your thought, well. 361 00:20:29,920 --> 00:20:31,760 Speaker 5: I'm going to disagree with part of that, but I 362 00:20:31,800 --> 00:20:36,720 Speaker 5: agree with a lot of it as well. In my world, 363 00:20:36,760 --> 00:20:41,040 Speaker 5: when you have a self interested explanation or something, you 364 00:20:41,080 --> 00:20:43,879 Speaker 5: probably don't have to look very far for any other explanation. 365 00:20:44,040 --> 00:20:49,040 Speaker 5: Self interest usually is a pretty good explanation. And the reason, 366 00:20:49,320 --> 00:20:52,200 Speaker 5: you know, some people say, oh, the reason that doctors 367 00:20:52,240 --> 00:20:55,600 Speaker 5: overtreat is because they're afraid of being sued. Well, there's 368 00:20:55,640 --> 00:20:58,679 Speaker 5: a simpler self interested explanation, which is every time they 369 00:20:58,760 --> 00:21:03,639 Speaker 5: treat somebody, they make money, and until you take the 370 00:21:03,720 --> 00:21:08,600 Speaker 5: profit out of these services, which will never happen, it's 371 00:21:08,720 --> 00:21:12,480 Speaker 5: very hard to determine that they're actually engaging in any 372 00:21:13,160 --> 00:21:18,240 Speaker 5: real defensive medicine at all. There are lots of studies 373 00:21:18,280 --> 00:21:20,159 Speaker 5: that are out there now that have found. 374 00:21:19,960 --> 00:21:22,520 Speaker 1: That, I mean, defensive medicine is kind. 375 00:21:22,359 --> 00:21:27,280 Speaker 5: Of hard to define because it can be both it 376 00:21:27,320 --> 00:21:30,320 Speaker 5: can be both the provision of services that aren't needed 377 00:21:31,000 --> 00:21:34,720 Speaker 5: and the avoidance of services that are needed, because you 378 00:21:34,800 --> 00:21:37,600 Speaker 5: get sued when you do deliver services as well as 379 00:21:37,640 --> 00:21:40,600 Speaker 5: when you withhold them. So it's hard to figure out 380 00:21:41,000 --> 00:21:43,960 Speaker 5: exactly what's going on with defensive medicine. But as I said, 381 00:21:44,000 --> 00:21:45,879 Speaker 5: I don't think we really need to worry about it 382 00:21:46,000 --> 00:21:49,280 Speaker 5: very much because we have a self interested explanation, which 383 00:21:49,320 --> 00:21:52,679 Speaker 5: is that the services are profitable. And there's also you know, 384 00:21:52,800 --> 00:21:55,919 Speaker 5: doctors have a lot of confidence in their ability to 385 00:21:55,960 --> 00:21:58,320 Speaker 5: help people, and they have a very strong desire to 386 00:21:58,440 --> 00:21:59,080 Speaker 5: help people. 387 00:21:59,200 --> 00:22:01,199 Speaker 1: Right, that's what it should be. 388 00:22:01,560 --> 00:22:01,760 Speaker 5: You know. 389 00:22:01,880 --> 00:22:05,880 Speaker 3: You remind me of another great document written in seventeen 390 00:22:05,960 --> 00:22:09,280 Speaker 3: seventy six, and that from a Scotsman named Adam Smith, 391 00:22:09,359 --> 00:22:11,840 Speaker 3: who famously said, it is not from the benevolence of 392 00:22:11,880 --> 00:22:14,199 Speaker 3: the butcher, or the brewer or the baker that we 393 00:22:14,280 --> 00:22:18,360 Speaker 3: expect our dinner, but from their regard to their own 394 00:22:18,480 --> 00:22:24,959 Speaker 3: self interest. And exactly self interest drives so many things. 395 00:22:25,320 --> 00:22:27,960 Speaker 3: That guy is not standing on his feet behind the 396 00:22:28,000 --> 00:22:30,159 Speaker 3: counter at the donut shop for so many hours and 397 00:22:30,200 --> 00:22:32,640 Speaker 3: didn't get there at two thirty this morning because he's 398 00:22:32,680 --> 00:22:33,480 Speaker 3: a nice guy. 399 00:22:34,000 --> 00:22:36,760 Speaker 4: He wants to make a profit off the donuts. 400 00:22:36,800 --> 00:22:39,680 Speaker 3: I get to enjoy the donuts in exchange for the 401 00:22:39,760 --> 00:22:42,440 Speaker 3: currency that I was given for the sweat of my brow. 402 00:22:42,840 --> 00:22:45,280 Speaker 4: It works, and I think we have to return that 403 00:22:45,359 --> 00:22:47,320 Speaker 4: to the process. And I think that's where you and 404 00:22:47,400 --> 00:22:48,320 Speaker 4: I can agree. 405 00:22:49,480 --> 00:22:51,240 Speaker 5: I think we do agree on that, but we also 406 00:22:51,320 --> 00:22:57,560 Speaker 5: agree that I mean, these social programs have fundamentally undermined 407 00:22:57,880 --> 00:23:06,119 Speaker 5: the incentive to save and to be self reliant. 408 00:23:04,560 --> 00:23:08,560 Speaker 1: You know, the I think, you know, I constantly. 409 00:23:08,080 --> 00:23:12,080 Speaker 5: Read articles about how many people are retiring and all 410 00:23:12,119 --> 00:23:15,040 Speaker 5: they have to live on is social security and medicare 411 00:23:15,080 --> 00:23:18,159 Speaker 5: They don't have much in the way of savings. And 412 00:23:18,280 --> 00:23:21,360 Speaker 5: people say, well, how could you possibly you know, let 413 00:23:21,400 --> 00:23:21,959 Speaker 5: that happen? 414 00:23:22,080 --> 00:23:22,240 Speaker 6: Right? 415 00:23:22,280 --> 00:23:24,600 Speaker 5: Why are you buying, as you put it, those you know, 416 00:23:25,240 --> 00:23:27,600 Speaker 5: big screen TVs for every room when you should be 417 00:23:27,640 --> 00:23:31,000 Speaker 5: saving for your later years. I think the answer is 418 00:23:31,000 --> 00:23:33,720 Speaker 5: that most people naively think, oh, the government's just going 419 00:23:33,800 --> 00:23:36,280 Speaker 5: to take care of me in my later years, so 420 00:23:36,600 --> 00:23:39,679 Speaker 5: I don't have to save, and they, you know, the 421 00:23:39,760 --> 00:23:43,600 Speaker 5: temptation to spend money now rather than later, it's always there. 422 00:23:43,680 --> 00:23:45,720 Speaker 5: Who wants to save? Saving is boring? 423 00:23:45,920 --> 00:23:46,080 Speaker 1: Right? 424 00:23:47,200 --> 00:23:51,280 Speaker 5: Consuming today is fun? So, you know, I think that 425 00:23:52,160 --> 00:23:56,239 Speaker 5: as long as we have these paygo programs where you 426 00:23:56,240 --> 00:23:59,560 Speaker 5: know you can keep getting money out above what you 427 00:23:59,600 --> 00:24:05,280 Speaker 5: put in, that the incentives to save will forever be undermined. 428 00:24:06,000 --> 00:24:08,879 Speaker 5: And that's a terrible thing, I think, because, as you said, 429 00:24:08,920 --> 00:24:12,199 Speaker 5: you know, we're just getting ourselves into this world where 430 00:24:12,680 --> 00:24:15,360 Speaker 5: each of us expects everybody else to pay for everything 431 00:24:15,400 --> 00:24:19,320 Speaker 5: that we need. If it's only healthcare, they still expect 432 00:24:19,320 --> 00:24:22,080 Speaker 5: to pay for everything that they want, and that just 433 00:24:22,280 --> 00:24:25,840 Speaker 5: drives costs through the roof without really any offsetting benefits 434 00:24:25,920 --> 00:24:26,960 Speaker 5: that make sense of it. 435 00:24:27,480 --> 00:24:32,120 Speaker 3: Zoologists will tell you you are doing great harm by 436 00:24:32,160 --> 00:24:37,080 Speaker 3: domesticating certain breeds of animals, particularly if you intend at 437 00:24:37,160 --> 00:24:39,439 Speaker 3: some point to release them into the wild. 438 00:24:39,520 --> 00:24:40,640 Speaker 4: You make them slaves. 439 00:24:40,720 --> 00:24:45,640 Speaker 3: They lose the very abilities, and we've seen with evolutionary 440 00:24:45,680 --> 00:24:48,919 Speaker 3: studies that teeth are not as sharpenning longer, claws are 441 00:24:48,960 --> 00:24:51,480 Speaker 3: not as sharpenning more, they can no longer run as fast. 442 00:24:51,840 --> 00:24:56,399 Speaker 3: They grow to be like prison inmates, dependent on someone 443 00:24:56,440 --> 00:24:59,920 Speaker 3: else to provide for them, and I think that has 444 00:25:00,160 --> 00:25:04,119 Speaker 3: to be understood by people. Our guest is Professor Charles Silver, 445 00:25:04,160 --> 00:25:06,040 Speaker 3: who will be with us for one more segment. The 446 00:25:06,080 --> 00:25:10,480 Speaker 3: book is overcharged. Why Americans pay too much. 447 00:25:12,000 --> 00:25:15,159 Speaker 1: That's it. Arrest me or take me to Texas. So 448 00:25:15,640 --> 00:25:17,080 Speaker 1: many gets out of this state. 449 00:25:17,480 --> 00:25:21,320 Speaker 6: I think Michael Berry Robins show I like you. 450 00:25:23,560 --> 00:25:27,160 Speaker 3: Professor Charles Silver of the University of Texas School of Law, 451 00:25:27,240 --> 00:25:31,280 Speaker 3: my alma mater, has graciously spent quite a bit of 452 00:25:31,320 --> 00:25:36,080 Speaker 3: time with us discussing an area of his academic expertise 453 00:25:36,119 --> 00:25:39,399 Speaker 3: and prowess. The book is Overcharged, Why Americans pay too 454 00:25:39,480 --> 00:25:42,439 Speaker 3: much for healthcare? And folks, I have to say, as 455 00:25:42,920 --> 00:25:47,679 Speaker 3: you've heard me say many times, politics is interesting, you know, 456 00:25:48,000 --> 00:25:51,720 Speaker 3: the rooting for your team versus that team, the Trump Dance, 457 00:25:51,840 --> 00:25:54,200 Speaker 3: the reds and Blues, and who shows up and only. 458 00:25:54,600 --> 00:25:57,440 Speaker 3: But my primary interest at the end of the day 459 00:25:57,640 --> 00:26:00,080 Speaker 3: is not my team winning and your team losing. The 460 00:26:00,119 --> 00:26:05,960 Speaker 3: primary interest is creating a structure where the individual can thrive, 461 00:26:06,200 --> 00:26:10,040 Speaker 3: where there is opportunity and fairness, safeguard's rule of law, 462 00:26:11,280 --> 00:26:15,120 Speaker 3: and that will, at the end of the day, advance humanity. 463 00:26:15,320 --> 00:26:18,040 Speaker 3: It always has. It's the only thing that does not government. 464 00:26:18,520 --> 00:26:22,480 Speaker 3: And so these sort of policy discussions, I understand are 465 00:26:22,520 --> 00:26:26,480 Speaker 3: probably less thrilling than my usual screaming and hollering about 466 00:26:27,080 --> 00:26:29,879 Speaker 3: this or that indignity of the day. But this is 467 00:26:29,880 --> 00:26:33,880 Speaker 3: what matters. This is why we get involved in campaigns, 468 00:26:34,520 --> 00:26:36,520 Speaker 3: is to take control of the government and get it 469 00:26:36,560 --> 00:26:40,160 Speaker 3: out of our lives and create safeguards and reduce regulation 470 00:26:40,720 --> 00:26:43,560 Speaker 3: and promote the rule of law so that hardworking people 471 00:26:43,640 --> 00:26:46,399 Speaker 3: can create enough John Gault style for the rest of 472 00:26:46,520 --> 00:26:50,240 Speaker 3: us to prosper. And this stuff matters. So that's why 473 00:26:50,280 --> 00:26:56,040 Speaker 3: we have these conversations. Professor Charlesolver, overcharged, why Americans pay 474 00:26:56,160 --> 00:26:57,520 Speaker 3: too much for healthcare? 475 00:26:57,800 --> 00:27:00,560 Speaker 4: Professor Silver, I want you to be king for a day. 476 00:27:00,640 --> 00:27:01,400 Speaker 4: You have no. 477 00:27:03,160 --> 00:27:09,720 Speaker 3: As this benevolent monarch, you have no political concerns. Reconstruct 478 00:27:09,960 --> 00:27:13,879 Speaker 3: our health care facility to provide an opportunity for the 479 00:27:13,920 --> 00:27:17,680 Speaker 3: most healing to occur and the individuals to take control 480 00:27:17,800 --> 00:27:18,840 Speaker 3: of their own healthcare. 481 00:27:18,920 --> 00:27:19,800 Speaker 4: What does that look like? 482 00:27:22,320 --> 00:27:25,520 Speaker 5: Wow, I'm nervous about being king for a day because 483 00:27:25,880 --> 00:27:29,960 Speaker 5: I don't believe in kings, I know, but I'll try. 484 00:27:31,880 --> 00:27:35,639 Speaker 5: I think we basically wipe away everything in terms of 485 00:27:36,480 --> 00:27:41,240 Speaker 5: these programs and the restrictive regulations. You know, have you 486 00:27:41,240 --> 00:27:43,200 Speaker 5: ever heard of a certificate of need law? 487 00:27:43,400 --> 00:27:46,840 Speaker 1: I don't know. They're called con laws by for short, 488 00:27:46,920 --> 00:27:48,080 Speaker 1: but con. 489 00:27:47,920 --> 00:27:54,800 Speaker 5: Laws regulate how many new healthcare providers can set up shops. 490 00:27:54,800 --> 00:27:56,640 Speaker 5: So if you want to open a hospital, you got 491 00:27:56,680 --> 00:27:59,560 Speaker 5: to get permission. Oh okay, I guess what the way 492 00:27:59,600 --> 00:28:04,360 Speaker 5: the common laws work. The existing hospitals have a vote 493 00:28:04,400 --> 00:28:07,359 Speaker 5: and whether you can open a new hospital, or like 494 00:28:07,440 --> 00:28:11,360 Speaker 5: giving McDonald's a vote on whether Burger King can open 495 00:28:11,400 --> 00:28:13,000 Speaker 5: a restaurant right across the street. 496 00:28:14,440 --> 00:28:16,120 Speaker 1: It just doesn't make any sense. 497 00:28:15,960 --> 00:28:18,160 Speaker 5: But that's the way I would get rid of all 498 00:28:18,240 --> 00:28:22,239 Speaker 5: of those supply constraining regulations, and I would get rid 499 00:28:22,320 --> 00:28:28,080 Speaker 5: of all of these programs Obamacare, Medicare, whatever, and I 500 00:28:28,119 --> 00:28:33,760 Speaker 5: would go to a very simple wealth distribution program. I'm 501 00:28:33,760 --> 00:28:36,360 Speaker 5: not sure exactly how much money it should be. That's 502 00:28:36,359 --> 00:28:38,400 Speaker 5: something that has to have some work done. But you 503 00:28:38,400 --> 00:28:41,200 Speaker 5: know we're currently spending if you put all the healthcare 504 00:28:41,800 --> 00:28:46,920 Speaker 5: programs together, you know, we're spending like seven eight ten 505 00:28:47,040 --> 00:28:50,640 Speaker 5: thousand dollars a person per you know, per American through 506 00:28:50,680 --> 00:28:53,600 Speaker 5: these programs. If we just took some of that money 507 00:28:54,240 --> 00:28:59,080 Speaker 5: and started plunking it into restricted healthcare savings accounts for 508 00:28:59,160 --> 00:29:02,000 Speaker 5: people year, you know, there's just a little bit more 509 00:29:02,040 --> 00:29:05,440 Speaker 5: that's put in. Pretty soon everybody would have enough money 510 00:29:05,440 --> 00:29:09,520 Speaker 5: to pay for their basic needs and to buy catastrophic insurance, 511 00:29:09,520 --> 00:29:13,160 Speaker 5: and I would let people buy just as much catastrophic 512 00:29:13,240 --> 00:29:14,520 Speaker 5: insurance as they want. 513 00:29:14,960 --> 00:29:16,800 Speaker 1: I wouldn't have coverage mandates. 514 00:29:16,840 --> 00:29:19,479 Speaker 5: You know, right now, if you want to buy a 515 00:29:19,520 --> 00:29:22,600 Speaker 5: policy on one of the exchanges and you're a young man, 516 00:29:24,640 --> 00:29:28,920 Speaker 5: you know you have to pay for annual mammograms, right, 517 00:29:29,600 --> 00:29:33,800 Speaker 5: but you're not getting mammograms because you're a man, right right, 518 00:29:34,040 --> 00:29:37,280 Speaker 5: So you know, I wouldn't force people to buy any 519 00:29:37,320 --> 00:29:40,920 Speaker 5: particular amount of coverage. And I would let insurance companies 520 00:29:41,080 --> 00:29:44,720 Speaker 5: limit the total payouts, which you know, that's. 521 00:29:44,520 --> 00:29:47,960 Speaker 1: Really where things are screwed up right now. 522 00:29:47,960 --> 00:29:49,680 Speaker 5: It's one of the areas, right they have to spend 523 00:29:49,760 --> 00:29:53,040 Speaker 5: unlimited amounts of money on people. I would let people 524 00:29:53,120 --> 00:29:57,800 Speaker 5: let design their own insurance programs, and I think that 525 00:29:57,880 --> 00:29:59,680 Speaker 5: you know, it's not going to work perfectly. Nothing ever 526 00:29:59,720 --> 00:30:02,720 Speaker 5: works perfectly, right, But it would work so much better 527 00:30:03,280 --> 00:30:06,600 Speaker 5: and be so much more efficient than the existing system, 528 00:30:06,640 --> 00:30:10,600 Speaker 5: and it'd be way more consumer friendly. And that's a 529 00:30:10,720 --> 00:30:15,000 Speaker 5: huge improvement because I don't know anybody who is happy 530 00:30:15,040 --> 00:30:18,719 Speaker 5: with the existing healthcare system. I mean, this terrible murder 531 00:30:18,760 --> 00:30:24,960 Speaker 5: that just occurred has brought to the surface the extraordinary 532 00:30:25,040 --> 00:30:30,280 Speaker 5: hatred that people have toward insurance companies. You know, that's 533 00:30:30,440 --> 00:30:33,960 Speaker 5: just one symptom. We're spending twice as much as any 534 00:30:34,000 --> 00:30:37,560 Speaker 5: other country on healthcare, and we're getting less and less 535 00:30:37,600 --> 00:30:42,360 Speaker 5: healthy every year. You know, our life expectancy is declining. 536 00:30:42,880 --> 00:30:45,640 Speaker 5: We're just doing everything wrong that we possibly can do. 537 00:30:45,760 --> 00:30:48,680 Speaker 5: So wipe the slate, get rid of all this stuff. 538 00:30:48,760 --> 00:30:53,080 Speaker 5: Start out with a really simple direct payment system and 539 00:30:53,120 --> 00:30:55,880 Speaker 5: a cash transfer system to deal with people who are 540 00:30:55,880 --> 00:30:59,760 Speaker 5: so poor that they can't even afford the basics, and 541 00:31:00,640 --> 00:31:03,080 Speaker 5: just be satisfied with that. I said, it's not gonna 542 00:31:03,080 --> 00:31:06,200 Speaker 5: be perfect, but it'd be hard to improve on all, right. 543 00:31:06,120 --> 00:31:10,880 Speaker 3: Yeah, And to get outside the purview of what we've discussed, 544 00:31:10,880 --> 00:31:13,640 Speaker 3: but to speak more to the process that lands us 545 00:31:14,040 --> 00:31:14,760 Speaker 3: where we are. 546 00:31:15,600 --> 00:31:16,880 Speaker 4: Our criminal justice system. 547 00:31:16,920 --> 00:31:21,640 Speaker 3: We spend more on imprisoning and prosecuting and chasing down 548 00:31:21,720 --> 00:31:23,800 Speaker 3: bad guys in any other country in the world. 549 00:31:24,160 --> 00:31:25,520 Speaker 4: And yes, I think we do. 550 00:31:25,440 --> 00:31:29,600 Speaker 3: A far worse job, at less effective job than most 551 00:31:29,600 --> 00:31:30,480 Speaker 3: countries in the world. 552 00:31:30,480 --> 00:31:33,680 Speaker 4: And I think much of that you can see. 553 00:31:33,480 --> 00:31:38,440 Speaker 3: Some similarities and patterns that pervade those two industries. And 554 00:31:38,480 --> 00:31:41,280 Speaker 3: by the way, then we could move over into public 555 00:31:41,400 --> 00:31:43,400 Speaker 3: education and education generally. 556 00:31:44,920 --> 00:31:45,280 Speaker 1: There are a. 557 00:31:45,360 --> 00:31:51,080 Speaker 3: Number of different applications for where this process has gone wrong, 558 00:31:51,320 --> 00:31:56,880 Speaker 3: and it is frustrating. I very much appreciate your time, professor, 559 00:32:00,080 --> 00:32:03,600 Speaker 3: feel the better for it. The book is overcharged Why 560 00:32:03,640 --> 00:32:08,000 Speaker 3: Americans pay too much for healthcare? Professor Charles Silver of 561 00:32:08,120 --> 00:32:10,160 Speaker 3: the University of Texas. 562 00:32:09,840 --> 00:32:13,440 Speaker 1: School of Law. Thank you, sir, Thank you, Michael pleasure. 563 00:32:13,680 --> 00:32:17,360 Speaker 3: And with that, might I suggest to each and every 564 00:32:17,400 --> 00:32:21,320 Speaker 3: one of you that while politics is an interesting undertaking, 565 00:32:21,480 --> 00:32:25,120 Speaker 3: and it is you know, winning elections, and he said this, 566 00:32:25,200 --> 00:32:26,720 Speaker 3: and we're going to show him, and. 567 00:32:27,000 --> 00:32:29,840 Speaker 4: You know, it's a battle royale, and you. 568 00:32:29,800 --> 00:32:33,640 Speaker 3: Know I argued with my cousin at the Thanksgiving table, 569 00:32:35,560 --> 00:32:40,040 Speaker 3: at the end of it all, the reason for the arguments, 570 00:32:40,400 --> 00:32:49,240 Speaker 3: reason for the elections should be very redemptive, very practical, 571 00:32:49,320 --> 00:32:53,760 Speaker 3: not just existential, not just ideological. They're real to your life, 572 00:32:54,640 --> 00:33:02,480 Speaker 3: and that is creating a governmental system where individuals are 573 00:33:02,640 --> 00:33:08,640 Speaker 3: free to thrive. Government is not just. Government is not merciful. 574 00:33:09,120 --> 00:33:15,560 Speaker 3: Government is not protective, It is not good. Government is clunky, 575 00:33:15,600 --> 00:33:19,520 Speaker 3: it's inefficient. If you've stood in line of the DPS 576 00:33:19,640 --> 00:33:22,040 Speaker 3: office to get your driver's license and thought to yourself, 577 00:33:22,240 --> 00:33:25,920 Speaker 3: you could move this thing along. If you've seen someone 578 00:33:26,480 --> 00:33:29,400 Speaker 3: who is on the clock and doesn't care about results. 579 00:33:30,320 --> 00:33:33,880 Speaker 3: If you've seen the worst of government in every aspect, 580 00:33:34,000 --> 00:33:36,680 Speaker 3: whether it's the inspector who doesn't seem to care, that 581 00:33:36,720 --> 00:33:40,080 Speaker 3: they're coming back and adding these regulations that are going 582 00:33:40,160 --> 00:33:41,760 Speaker 3: to cost this much more for you to build this, 583 00:33:41,800 --> 00:33:43,560 Speaker 3: and now you're going to walk away from the project 584 00:33:43,560 --> 00:33:47,320 Speaker 3: and lead the property vacant, and that's not good for anybody. 585 00:33:47,560 --> 00:33:48,160 Speaker 1: These are the. 586 00:33:48,200 --> 00:33:49,920 Speaker 4: Things that we should spend our time with. 587 00:33:51,040 --> 00:33:55,400 Speaker 3: And I say this because politics has become sport and 588 00:33:55,480 --> 00:33:56,640 Speaker 3: it's become for many. 589 00:33:56,480 --> 00:33:57,800 Speaker 4: People their favorite hobby. 590 00:33:58,200 --> 00:34:00,240 Speaker 3: But let's not lose track of what we're trying trying 591 00:34:00,240 --> 00:34:03,440 Speaker 3: to do here, which is literal, not to exaggerate, to 592 00:34:03,520 --> 00:34:04,280 Speaker 3: save our country. 593 00:34:04,840 --> 00:34:07,520 Speaker 4: Exelman Els has left the building. 594 00:34:07,960 --> 00:34:09,600 Speaker 1: Thank you, and good night.