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Speaker 1: Brought to you by the reinvented two thousand twelve camera.

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Speaker 1: It's ready. Are you welcome to Stuff you Should Know

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Speaker 1: from House Stuff Works dot Com. Hey, and welcome to

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Speaker 1: the podcast. I'm Josh Clark. With me, as always is

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Speaker 1: Charles W. Chuck Bryant, Doctor. And with Charles W. Chuck

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Speaker 1: Bryant is Molly Edmonds of Stuff Mom Never Told You Fame,

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Speaker 1: one of our sister podcasts, and Molly has also been

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Speaker 1: doing more research into healthcare reform than me, Chuck and

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Speaker 1: Ram Emanuel Combine. So we're glad to have you here. Molly.

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Speaker 1: I think I could take down but you could. He's

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Speaker 1: a bulldog. Yeah, but I've seen you. Have you seen

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Speaker 1: her leg wrestle? No, but startling. I've been behind me

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Speaker 1: in front of her sights. Sure, I'm not a pleasant day. Yeah,

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Speaker 1: I have to chuck it, which is why we're scared

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Speaker 1: of Molly. But we're glad she's here, right Maum, I hope,

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Speaker 1: So I hope you're glad I'm here. We're also glad

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Speaker 1: you're here because, like the Necronomicon podcast, we intend to

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Speaker 1: use you as a shield. Just to get that out

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Speaker 1: of the way, let's talk about healthcare form. All right.

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Speaker 1: I want to also say that we are not going

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Speaker 1: to be discussing any of the politics in this one.

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Speaker 1: This is part two, you lie. Except for that part. Um,

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Speaker 1: We're not going to be discussing any of the politics.

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Speaker 1: What we're gonna do is simply present, uh, the proposals

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Speaker 1: that are in play right now. And then Part three

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Speaker 1: is going to be criticisms, pros cons maybe other ideas

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Speaker 1: for fixing the health care system. And then part four

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Speaker 1: is what I'm excited about, myths and truths. Yes, yeah,

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Speaker 1: we're going to be talking about just outright lies, things

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Speaker 1: that are kind of on the fence, and things that

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Speaker 1: actually are true but are discussing. Um, so let's talk

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Speaker 1: about Obama's proposal. Is it even Obama's proposal? You know,

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Speaker 1: Obama has made this a priority in his presidency, but

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Speaker 1: big time, but he has not come down from on

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Speaker 1: high with a massive plan for us all to reactive.

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Speaker 1: You know who did do that? The Clintons. The Clintons did,

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Speaker 1: that's right, and Moses Moses. Uh, that was on the

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Speaker 1: third tablet right yea, Um there tablet was dropped. Yeah,

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Speaker 1: the Clintons actually wrote legislation and we're peddling it around

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Speaker 1: Capitol Hill in the nineties and it didn't work. That

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Speaker 1: that plan didn't work, So clearly Obama learned from his predecessors, right, right,

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Speaker 1: So Obama has laid out eight principles. This is what

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Speaker 1: he did early on. I think this has gotten lost

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Speaker 1: in all the hubbu but he came out with a

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Speaker 1: principles UM and then left it to Congress as five

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Speaker 1: companies from Congress to create plans. And then in the

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Speaker 1: week we're recording this, he came out and made this

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Speaker 1: mega speech that's come up with you know, all this attention.

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Speaker 1: So now the week we're recording this, Obama has come

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Speaker 1: back out with the speech and made it made it

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Speaker 1: look like it's a little bit more of his plan,

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Speaker 1: tried to wrestle control away from you know, the media spin.

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Speaker 1: He's saying what he wants in a plan, what he

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Speaker 1: doesn't want, what he's open to compromise about. UM. But

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Speaker 1: let's start in campaign mode. He was he's definitely back

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Speaker 1: from vacation. Yeah, yeah, So should we talk about his

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Speaker 1: A proposals. Let's let's say, I mean, what we're talking

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Speaker 1: about A thousand pages pages are so of legislation right now, right,

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Speaker 1: we got we got two bills on the table from

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Speaker 1: four committees. And when he says there are four committees

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Speaker 1: who have come up with bills, one of the bills

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Speaker 1: is a try committee bill, so that's where that comes from.

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Speaker 1: Three committees came up with one bill um from the

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Speaker 1: House HR three two zero zero, and then the Senate

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Speaker 1: has a bill. I have to point this out. I'm sorry,

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Speaker 1: Molly didn't even look at her notes to writt along

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Speaker 1: that bill number. I'm just gonna excuse myself to dream

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Speaker 1: about HR three two zero zero. I bet you do.

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Speaker 1: At this point she didn't look at her notes again.

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Speaker 1: And you know what I have anxiety dreams about is

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Speaker 1: the upcoming Senate Finance Committee bills. So by the time

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Speaker 1: people hear this, that bill might become might be out.

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Speaker 1: It's the trifecta. It's the one everyone's waiting for because

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Speaker 1: it's a bipartisan committee. Um being the Senate Finance Committee,

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Speaker 1: they have to say how they're going to pay for it,

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Speaker 1: which the other bills were not as on the hook for.

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Speaker 1: So you know that's the one everyone's waiting on. Beta breath. Yeah. Actually,

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Speaker 1: I saw today breaking news was that the chairman of

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Speaker 1: that commit. The Democrat Max Bacchus basically said, we're pushing

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Speaker 1: through with this very soon, and it doesn't matter if

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Speaker 1: I have Republican sport or not. We're gonna push it

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Speaker 1: through and we'll have it for a review by the

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Speaker 1: twenty one September. So wow, that's the latest word. Yeah,

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Speaker 1: I have dreams about Max. Now do you really that's nice?

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Speaker 1: So um, anyway, that's a personal note. So Obama says,

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Speaker 1: here the here are the eight things that he saw

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Speaker 1: that he wanted in the plan. Okay, he wanted to

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Speaker 1: assure affordable, quality health coverage for all Americans. You guys

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Speaker 1: want to I'll do one, yeah, yeah, I'll go next.

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Speaker 1: He wants to remove obstacles to coverage for people with

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Speaker 1: pre existing conditions. He wants to invest in prevention and wellness.

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Speaker 1: He wants to maintain coverage in the event of job

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Speaker 1: loss or change. He wants to kill your grandparents. Oh,

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Speaker 1: I'm sorry. Now. He wants to improve quality care and

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Speaker 1: patient safety. Right uh? And uh, let's see. He wants

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Speaker 1: to guarantee choice of doctors and coverage plans, right yes,

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Speaker 1: and safeguard families from bankruptcies related to health expenses. I

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Speaker 1: think that's seven. He wants to the final one he

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Speaker 1: wants to shrink long term cost increases in healthcare for

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Speaker 1: businesses and the government. So those are pretty um broad principles.

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Speaker 1: I think you'd be hard pressed to find someone who

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Speaker 1: would disagree with these principles just it's got and theory.

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Speaker 1: But then the Congress had the hard job of making

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Speaker 1: them into bills. So we have that thousand pages of

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Speaker 1: legislation as it stands right now, not including the Senate

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Speaker 1: Finance committment, without the Senate Finance correct in Brail, which

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Speaker 1: was she taught herself, had translated and then read in.

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Speaker 1: So so let's talk about how Congress did take these

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Speaker 1: eight principles and turn them into healthcare. As you were saying, um,

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Speaker 1: let's start with individuals. One of the big things is

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Speaker 1: that everyone, Both of both of the proposals that are

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Speaker 1: out right now say that everyone has to have health insurance. Yeah,

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Speaker 1: it's an individual mandate, and you know it's it's sort

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Speaker 1: of borrowing an idea from car insurance. If we've all

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Speaker 1: got to carry car insurance, then you know, what's what's

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Speaker 1: health insurance in addition to that? Right, So if you

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Speaker 1: don't have health insurance. You don't have to stormtroopers aren't

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Speaker 1: going to come to your house and beat your kids

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Speaker 1: in front of you. But the tax man, well right, yeah,

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Speaker 1: because I think the Senate bill says you pay seven

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Speaker 1: fifty dollars a year in tax penalties for not having insurance.

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Speaker 1: And then the house plan is I think up to

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Speaker 1: two point five percent of your adjusted income. Yeah, but

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Speaker 1: no more than the lowest price plan. Right, Like, they're

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Speaker 1: not going to charge you more than you would have

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Speaker 1: to pay your health insurance, right, I mean, if you

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Speaker 1: if you can pay the premium and taxes, essentially you

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Speaker 1: could just pay the premium. Well that's the way I

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Speaker 1: took it is we're going to get some money, so

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Speaker 1: you might as well, hint, hint, to go spending on

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Speaker 1: healthcare ether than funding the I R S. Right, But

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Speaker 1: now most people already have health insurance. The majority people

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Speaker 1: get it from their employers, and so that's pretty easy

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Speaker 1: to to meet that requirement, right, But we don't want

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Speaker 1: the employer to just chicken out, So employers have a

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Speaker 1: mandate as well, exactly. So now we have to mandates

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Speaker 1: employer and individual. And I heard actually the Senate Finance

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Speaker 1: is not going to have an employee an employer mandate,

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Speaker 1: and that's why businesses are probably gonna be a little

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Speaker 1: more favorable that I said. You know, that's one of

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Speaker 1: the theories that that's what killed Clinton's bills. You know,

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Speaker 1: it's a job killer, right, So um, but that that

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Speaker 1: sounds kind of political. So let's just back off and

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Speaker 1: say you're an employer, you're in an individual, You've got

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Speaker 1: this mandate. What if you can't afford it? Well, there's subsidies. Yes, Well,

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Speaker 1: not only subsidies. I mean, if you are going to

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Speaker 1: mandate that everybody has to have health insurance, you have

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Speaker 1: to make exemptions for certain people. Um, but you also

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Speaker 1: we already have Medicaid Medicare, so that covers automatically a

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Speaker 1: certain percentage of Americans. But they're also expanding Medicaid, right,

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Speaker 1: I think two power Yeah, that is the current Senate

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Speaker 1: plan would be a hundred about the federal power level,

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Speaker 1: and the House would do a hundred of the federal

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Speaker 1: powery level. Right. And they're also planning on kind of

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Speaker 1: cleaning house in those two systems, right and making them

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Speaker 1: more efficient and cheaper. Yes, hopefully. Yeah, Well we'll get

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Speaker 1: to that when we start talking about how this is

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Speaker 1: going to be paid for? UM. But let's talk about

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Speaker 1: subsidies for individuals. UM. Let's say that, Oh, I don't know,

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Speaker 1: I make three hundred and fifty percent income above the

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Speaker 1: federal poverty level. Right, Well, I know they're to dream.

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Speaker 1: Will will I be eligible for subsidies? Yes? Yes, Okay,

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Speaker 1: So I think it goes from Uh, let's say if

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Speaker 1: we're going with a hundred and fifty percent above poverty level. Uh.

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Speaker 1: From that to poverty level you're covered by medicaid. From

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Speaker 1: a hundred up to what is it? Uh, you're eligible

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Speaker 1: for subsidies on a sliding scale only. Right. What they

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Speaker 1: do is, obviously, if you make a little bit more money,

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Speaker 1: if you're closer to that level of the federal poverty level,

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Speaker 1: you will pay a greater amount of the premium than

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Speaker 1: if you were just making a hundred five of the

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Speaker 1: federal pobby level. So in the House Committee, for example,

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Speaker 1: you get your subsidy, but you will pay Let's say

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Speaker 1: you were at three fifty, You're gonna people still paying

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Speaker 1: your income toward the thing, and but then you also

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Speaker 1: get a subsidy to cover the rest of the premium.

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Speaker 1: Kind Of like when I go to my shrink and

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Speaker 1: I say, dude, I make a year and he doesn't

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Speaker 1: charge me as much as the physician. It comesn't after me. Yeah,

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Speaker 1: that's actually a really good point, Chuck, that there's a

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Speaker 1: lot of um, a lot of key points in these

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Speaker 1: proposals are already in effect in some ways either um

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Speaker 1: de facto like your your shrink charging you on a

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Speaker 1: sliding scale, or you know, um mandates about everyone having

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Speaker 1: to have insurance like that the Massachusetts experiment. Right, So

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Speaker 1: this is kind of taking a lot of maybe good

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Speaker 1: ideas and putting them together, a good ideas being a

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Speaker 1: very political way to put it. Right, what's the Massachusetts

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Speaker 1: experiment where everyone has to have insurance? I don't think

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Speaker 1: I knew that? Yeah, wow, Yes, And you know, that's

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Speaker 1: probably a good thing for you guys to discuss in

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Speaker 1: the next podcast, because I mean, is the Massachusetts a

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Speaker 1: success in terms of its health insurance? So, um, where

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Speaker 1: is everybody going to get this insurance? There's an insurance

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Speaker 1: marketplace that's being set up, right, Yeah, this is sort

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Speaker 1: of the new big thing. Um. So the insurance marketplace

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Speaker 1: is sort of this attempt to have the general public

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Speaker 1: get their insurance the same way that Congress people do, right,

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Speaker 1: because essentially, when you become elected to Congress, you are

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Speaker 1: presented with five plans. Are not not five, that's not

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Speaker 1: I mean it's not a specific number. But basically you're

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Speaker 1: offered all these plans that tell you exactly how much

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Speaker 1: it's going to cost and what benefits are provided. And

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Speaker 1: it's very easy to use. Yeah, I think plain language

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Speaker 1: is one of the provisions in at least the House

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Speaker 1: Bill Transparency Plan language. Yeah, like you have to say

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Speaker 1: this is what's covered, and this is what's not covered,

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Speaker 1: and this is what you get for what you pay for. Right. Like,

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Speaker 1: plain language is a really big part of this. So

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Speaker 1: if you're trying to fulfill your individual mandate, you will

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Speaker 1: look at all these plans and say, well, I want

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Speaker 1: this one because I know it costs this much and

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Speaker 1: I know that this, this, and this and is covered.

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Speaker 1: And in both of these bills, every plan that's in

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Speaker 1: that marketplace will will have a certain set of minimum

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Speaker 1: benefits that it wills that have to be in there,

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Speaker 1: and then there will be plans that are better than

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Speaker 1: that in terms of maybe you want you know, spaw

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Speaker 1: days covered or something like that you can pay to

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Speaker 1: get that extra. But let's say you just want to

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Speaker 1: be able to go get you know, a mammogram under

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Speaker 1: your health insurance plan. That's probably closer to what's going

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Speaker 1: to be considered an essential benefit that has to be

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Speaker 1: in the plan, right and it gets will get into

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Speaker 1: this obviously latter two. But that's getting a little political

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Speaker 1: as well, with what can be covered and what's not right. Right,

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Speaker 1: But let's just for the time being called the minimum benefits,

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Speaker 1: because what we're what these proposals give the government license

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Speaker 1: to do, is to define what these minimum standards of

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Speaker 1: health insurance are, and eventually all health insurance plans, if

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Speaker 1: you are have an existing one, it will I have

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Speaker 1: about five years to meet these requirements as well, right,

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Speaker 1: but it won't change it first. Right now, they have

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Speaker 1: about a five year window grandfathered in for several years. Right.

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Speaker 1: And you staid in your article how healthcare reform works that, um,

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Speaker 1: these basic requirements will keep the marketplace from becoming like

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Speaker 1: a dumping ground for shoddy policies, right right, You know,

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Speaker 1: we don't want anyone in the marketplace who already maybe

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Speaker 1: doesn't have a job or can't afford regular insurance to

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Speaker 1: just be stuck with sort of um crappy coverage. I mean,

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Speaker 1: the whole point of this plan, whether you have insurance

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Speaker 1: or you don't have insurance. And Obama's point of view

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Speaker 1: is to strength and health insurance for everyone. Right, So obviously,

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Speaker 1: if you don't have a plan already, you're gonna want

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Speaker 1: sort of that basic care. But you also want to

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Speaker 1: make sure that the people who already have insurance are

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Speaker 1: being protected in the same way, right, right, right? Do

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Speaker 1: you know what insurance everyone should have? What motion picture

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Speaker 1: health and welfare? Is it good? It's like it's better

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Speaker 1: than the army. Did you get Spada? You get massage,

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Speaker 1: spa days, you get like Manny Petties paid for it. Actually,

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Speaker 1: because this is the first I've ever heard of spot date,

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Speaker 1: I think there's a sushi clause. You know, in Germany,

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Speaker 1: spots are included universal health care. That's wonderful. Um, small businesses,

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Speaker 1: you were saying that that businesses are going to have

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Speaker 1: a mandate to provide health insurance. Uh, they're also going

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Speaker 1: to be allowed to, um, go to this insurance marketplace

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Speaker 1: to select as well. Right, employers are going to be

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Speaker 1: subject to a payer play requirement where if you don't

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Speaker 1: provide health insurance for your employees. You're gonna have to

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Speaker 1: pay into a fund for all your employees who don't

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Speaker 1: have health insurance. Now, this would probably be a job

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Speaker 1: killer if it were to be applied to small businesses.

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Speaker 1: So small businesses will be exempt from this requirement, right.

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Speaker 1: I think Obama said small businesses in the US will

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Speaker 1: be exempted his recent speech, right, So, um, and and

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Speaker 1: the Senate and the House to find small businesses differently

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Speaker 1: in their current plan. They might look at how many

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Speaker 1: employees you have. They might look at your you know,

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Speaker 1: income per year. I think if you make more than

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Speaker 1: two dollars a year, you wouldn't be considered a small

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Speaker 1: business under this exemption. Um. But you know, that's that's

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Speaker 1: probably gonna be one of the things that's ironed out

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Speaker 1: and re examine pretty closely in the reconciliation of these

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Speaker 1: two bills. But um, they would also be eligible to

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Speaker 1: enter this marketplace and provide insurance to their employees with

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Speaker 1: the help of subsidies. Okay, And like people, those employers

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Speaker 1: that decide I'm not doing this, they are going to

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Speaker 1: have to pay, and that money will be contributed to

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Speaker 1: the insurance marketplace, right right, So either way, it's provide,

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Speaker 1: like you said, pay your play. Um. So in this marketplace,

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Speaker 1: let's all pretend that we're in there right now. Okay, closure, closure,

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Speaker 1: This is nice. Do you see all these little logos,

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Speaker 1: like there's Etna's logo, there's Snoopy, say hi to Snoopy.

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Speaker 1: Um do you see this one? What is that? Like

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Speaker 1: a screaming eagle with a bandaged head with the us

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Speaker 1: of a that is new or it would be if

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Speaker 1: this thing gets past. That's the public option, right, yes,

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Speaker 1: the public option has in one of the more controversial

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Speaker 1: parts of all these bills. Correct, yes, okay, so it's controversial.

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Speaker 1: What's what's what does it entail? What's going on here?

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Speaker 1: So the point of having this marketplace is one way

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Speaker 1: that Obama thinks we can keep our insurance companies honest

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Speaker 1: and competitive, because if you're competing against people, then you

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Speaker 1: will provide good service for good value. Makes sense? Makes sense? Now,

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Speaker 1: Obama thinks that one way to ensure that this happens

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Speaker 1: is to also introduce this public health insurance option. Um.

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Speaker 1: So that it's a government run option that will have

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Speaker 1: lower rates probably. Um Now, obviously right there, you're going

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Speaker 1: to have some contention about what the rate should be

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Speaker 1: because kind of private ensure compete with UM. You know,

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Speaker 1: a public ensure will have sort of the government um

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Speaker 1: stamp of approval that might make it impervious to any

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Speaker 1: sort of attack or disaster. UM. But the thinking is

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Speaker 1: is that, you know, similar to the way we provide

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Speaker 1: Medicare and Medicaid for certain people, that we would have

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Speaker 1: this option for people to UM get health insurance at

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Speaker 1: a pretty pretty affordable cost set by the government. But

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Speaker 1: we don't know what cost that would be yet, So

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Speaker 1: you really can't get into an argument about whether insurers

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Speaker 1: could compete. Are the financials not really set on this yet. No,

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Speaker 1: And you know, if you've been following the news, this

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Speaker 1: is probably the thing you see that, oh it's been dropped.

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Speaker 1: Oh it hasn't been dropped. We might have a co

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Speaker 1: op instead. UM. It's really something to watch. That was

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Speaker 1: something that in the speech Obama said he was willing

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Speaker 1: to negotiate on, so it's still to come. He has

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Speaker 1: said so far though, that it wouldn't be just another Medicare.

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Speaker 1: We wouldn't just have Medicare rates which are about lower

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Speaker 1: than most insurance rates, because that isn't fair to private insurers.

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Speaker 1: It would have to be UM similar to private insurance likely,

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Speaker 1: and it would also UM have to fund itself through premiums.

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Speaker 1: It would be self sustaining because I mean, if you've

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Speaker 1: got federal or injections of federal cash, you're not really

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Speaker 1: competing with anything, right, Yeah, And I think Obama said

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Speaker 1: that he wouldn't back anything to added to the deficit.

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Speaker 1: Is that correct? So that's the public option. Everybody back

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Speaker 1: away slowly. Well, you know one thing that might be

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Speaker 1: interesting to talk about is we always hear Obamas saying

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Speaker 1: that if you like your health insurance, you can keep it,

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Speaker 1: right right, If you like your health insurance, you can

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Speaker 1: keep it. The thing is it is Clinton saying no,

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Speaker 1: if you like your health insurance, you can keep it

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Speaker 1: there much better. But the thing is, let's think about

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Speaker 1: the people who don't like their health insurance and might

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Speaker 1: be thinking, oh, man, a public option sounds pretty good.

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Speaker 1: That's an excellent point because you never hear that mentioned. Um,

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Speaker 1: you know, you can't really opt out of your employer

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Speaker 1: based health insurance because you don't like it and just

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Speaker 1: get into a cheaper public option. You can't. Why not?

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Speaker 1: Because because you have the option through work so you're

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Speaker 1: immediately discounted. Because yes, but if right now the insurance

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Speaker 1: marketplace will only be open to those people who don't

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Speaker 1: have insurance through their employer at first, but I mean,

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Speaker 1: I don't if we're still five years away from a marketplace.

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Speaker 1: I think we'd be at least five years after that

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Speaker 1: away from allowing everyone in. So right now, you have

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Speaker 1: to stick with your employer based health insurance unless your

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Speaker 1: employer drops. You know, that's something that people are saying.

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Speaker 1: You know, if there's some cheap plan and employers figure

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Speaker 1: it's cheaper just to pay the fee than to cover

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Speaker 1: their employees, that could happen. But um, the thinking is

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Speaker 1: is that if if everyone has to know sort of

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Speaker 1: what their insurance cost versus what it costs in the marketplace,

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Speaker 1: then that competitive spirit might keep insurance fair and honest.

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Speaker 1: This canna get really tricky, so well, let's talk about

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Speaker 1: Let's talk some more about how insurance companies are going

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Speaker 1: to be effected. Just in addition to this possible competition

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Speaker 1: from a public option, there are some mandates in this legislation,

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Speaker 1: for example, that says you can't discriminate based on pre

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Speaker 1: existing conditions any longer. Obama likes to use that. Um.

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Speaker 1: The example of that woman who's denied that what wasn't

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Speaker 1: she was going to have a mastectomy, and then they

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Speaker 1: found out she didn't declare a case of acne from

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Speaker 1: her childhood, and thus they postponed the treatment on her

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Speaker 1: breast cancer grow right and and under under this proposal,

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Speaker 1: there's no more pre existing condition to niles and right

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Speaker 1: or and it, and it doesn't cost you more. You

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Speaker 1: can't be charged a higher premium because you have a

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Speaker 1: pre existing because they're gonna do with that completely for

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Speaker 1: people who have insurance and for people who are trying

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Speaker 1: to get insurance, like that's going man under this plan.

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Speaker 1: So if you smoke tin packs of cigarettes today and

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Speaker 1: you walk in there with an oxygen tank, they have

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Speaker 1: to cover you, Yeah, for the same amount of money. Yeah,

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Speaker 1: as far as I know about the country, that's awesome. UM.

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Speaker 1: There's also a mandate that, um, there can no longer

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Speaker 1: be caps on spending my insurance companies. And actually not

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Speaker 1: only that, the the the it's back on the consumer.

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Speaker 1: There's now a cap on how much a consumer can

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Speaker 1: pay out a pocket every year for their own healthcare.

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Speaker 1: Right because a lot of bankruptcies are driven by medical costs.

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Speaker 1: We're thinking that you know, if if there's if you

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Speaker 1: can't go broke because you're sick, then we will decrease

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Speaker 1: the number of bankruptcies. Damage right, the damage we might

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Speaker 1: be doing to our economy that way interesting definitely. Um

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Speaker 1: there then, so that's insurance companies. That's also again we're

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Speaker 1: just kind of hitting the high points here. We're talking about,

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Speaker 1: as Molly said, sixteen hundred pages of legislation as the

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Speaker 1: stands now. UM, So let's talk about UM Medicaid and Medicare.

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Speaker 1: Chuck mentioned this earlier about UM kind of cutting waste

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Speaker 1: in the Medicaid and Medicare system. Uh, and that actually,

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Speaker 1: let's talk about how much is this going to cost?

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Speaker 1: The OMB suggests it's going to be about a trillion

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Speaker 1: dollars over ten years for these these proposals for Obama's plan.

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Speaker 1: Obama is saying that two thirds of this can be

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Speaker 1: paid for right off the bat, just by cutting waste

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Speaker 1: with Medicare and Medicaid. What is he talking about, Well,

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Speaker 1: there's an estimate that about of the services that are

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Speaker 1: performed medically in this country are unnecessary. And that's overall,

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Speaker 1: that's not just Medicare, Medicaid adding a third limb, yeah, potentially,

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Speaker 1: or getting rid of that third limb that you wanted

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Speaker 1: to keep. Yeah, you know, either waste buddy, just blew

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Speaker 1: my mind. But to get rid of those costs right away, um,

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Speaker 1: and to also cut out some administrative costs all this

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Speaker 1: paper shuffling that a lot of people do, could um,

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Speaker 1: could help as well. The big the big name you

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Speaker 1: always hear in association to this is Medicare advantage, which

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Speaker 1: is a private program within the public program, which you know,

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Speaker 1: I don't know if that makes much sense, but it's

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Speaker 1: probably indicative of power whole health insurance system works. Um.

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Speaker 1: That's a hundand seventy billion a year that goes to

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Speaker 1: insurance companies for the exact same service that's provided to

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Speaker 1: people by the government. So they would cauld that and

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Speaker 1: shuffle them over to Medicare standard. No more advantage for you, right, right,

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Speaker 1: because it pays four more than regular Medicare for the

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Speaker 1: same exact same service. The people who would have just

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Speaker 1: stayed with regular Medicare, we could have saved a hundred

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Speaker 1: seventy billion year, right, But that's just that hundred seventy billion.

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Speaker 1: He's saying you can save another six billion just from

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Speaker 1: cutting waste, right. Uh, And I think he's all so

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Speaker 1: talking about bundling services that leads to bundling services, correct,

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Speaker 1: And that's a big deal. It's started his testing ground

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Speaker 1: for this because, as I said, this thirty percent waste

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Speaker 1: is endemic in the system. It's not just Medicare. It's

426
00:22:12,119 --> 00:22:13,959
Speaker 1: not just the government that can't run a program. It's

427
00:22:14,040 --> 00:22:16,480
Speaker 1: it's everyone who can't run a program. But they've done

428
00:22:16,480 --> 00:22:19,719
Speaker 1: these studies, um where they compare areas that spend a

429
00:22:19,720 --> 00:22:21,639
Speaker 1: lot of money on Medicare to just a little bit

430
00:22:21,680 --> 00:22:24,840
Speaker 1: of money on Medicare, and the people who have less

431
00:22:24,880 --> 00:22:28,400
Speaker 1: spent on them live longer and are healthier. The people

432
00:22:28,440 --> 00:22:31,200
Speaker 1: who have more doctors visits, more time in the hospital

433
00:22:31,440 --> 00:22:32,959
Speaker 1: are the ones that are more likely to die from

434
00:22:33,000 --> 00:22:35,960
Speaker 1: the exact same ailement that these lower spending people had

435
00:22:35,960 --> 00:22:38,320
Speaker 1: over here. So what can we do to emulate those

436
00:22:38,359 --> 00:22:41,639
Speaker 1: lower spending areas? Um, that's where we get this idea

437
00:22:41,640 --> 00:22:44,199
Speaker 1: of bundling that Josh was talking about. So if a

438
00:22:44,200 --> 00:22:46,679
Speaker 1: person goes into the hospital with a heart attack, instead

439
00:22:46,720 --> 00:22:49,119
Speaker 1: of you know, this doctor seeing him, then this doctor

440
00:22:49,160 --> 00:22:52,479
Speaker 1: see him, then this doctor see m and everyone charging

441
00:22:52,720 --> 00:22:55,920
Speaker 1: separately for all their tests for service be for service.

442
00:22:56,040 --> 00:22:57,760
Speaker 1: Then you know, you go into the hospital as a

443
00:22:57,760 --> 00:23:01,280
Speaker 1: Medicare patient and you are in there for your heart attack,

444
00:23:01,760 --> 00:23:03,959
Speaker 1: and all the treatment that you get relates to your

445
00:23:03,960 --> 00:23:06,720
Speaker 1: heart attack. Your doctors need to work together to figure

446
00:23:06,720 --> 00:23:09,240
Speaker 1: out the best course of treatment. And so it's it's

447
00:23:09,240 --> 00:23:10,719
Speaker 1: more a matter of how you kind of pay your

448
00:23:10,760 --> 00:23:12,919
Speaker 1: cable bill if you have your cable, your internet in

449
00:23:12,920 --> 00:23:16,400
Speaker 1: your phone altogether, Um, you just bundling. You just pay

450
00:23:16,480 --> 00:23:18,880
Speaker 1: one bill to the hospital for all that as opposed

451
00:23:18,880 --> 00:23:22,000
Speaker 1: to paying for your cardiogram and you know the m

452
00:23:22,080 --> 00:23:23,880
Speaker 1: R I scan they decides you need it and blah

453
00:23:23,920 --> 00:23:26,280
Speaker 1: blah blah. That kind of makes sense well, but it

454
00:23:26,320 --> 00:23:31,879
Speaker 1: also leads to another kind of um radical suggestion that's

455
00:23:32,000 --> 00:23:37,120
Speaker 1: found in these proposals is establishing what kind of care

456
00:23:37,720 --> 00:23:41,119
Speaker 1: you should follow when somebody comes into UH for a

457
00:23:41,160 --> 00:23:45,520
Speaker 1: heart attack, right, because how do you know how much

458
00:23:45,720 --> 00:23:49,439
Speaker 1: it should cost unless you know what procedures you have

459
00:23:49,520 --> 00:23:52,200
Speaker 1: to follow and how much those procedures should cost. So

460
00:23:52,359 --> 00:23:55,399
Speaker 1: to do that, they're setting up a panel that reviews

461
00:23:55,840 --> 00:23:59,480
Speaker 1: the effectiveness of methods of treatment and says this doesn't work,

462
00:23:59,720 --> 00:24:04,440
Speaker 1: this is success rate, So we're gonna go with this one, right, Well,

463
00:24:04,480 --> 00:24:06,080
Speaker 1: I don't think they're going to throw out this one.

464
00:24:06,280 --> 00:24:08,639
Speaker 1: I mean they obviously they don't want treatments that don't work.

465
00:24:09,080 --> 00:24:11,280
Speaker 1: But I think it's more And obviously I think we're

466
00:24:11,400 --> 00:24:14,359
Speaker 1: going to talk about rational healthcare in the next podcast.

467
00:24:14,800 --> 00:24:16,600
Speaker 1: But this is where people start to this idea. But

468
00:24:16,920 --> 00:24:19,719
Speaker 1: let's say that there are three treatments for a heart attack.

469
00:24:20,119 --> 00:24:22,960
Speaker 1: This one works, the first one works of population, the

470
00:24:23,000 --> 00:24:25,439
Speaker 1: second works for five percent of the population, and the

471
00:24:25,480 --> 00:24:28,120
Speaker 1: other one also works for five percent of population. Rather

472
00:24:28,160 --> 00:24:30,840
Speaker 1: than doing all three, do you have a greater chance

473
00:24:30,840 --> 00:24:33,280
Speaker 1: of starting with this one? Right? And if that doesn't work,

474
00:24:33,400 --> 00:24:38,520
Speaker 1: then go to one. It's the population, Yeah, be tearing

475
00:24:38,800 --> 00:24:41,760
Speaker 1: up sort of what works. But I think Obama has

476
00:24:41,800 --> 00:24:44,800
Speaker 1: been very clear that if your doctor thinks that he

477
00:24:44,880 --> 00:24:46,760
Speaker 1: wants to still go with number three that has the

478
00:24:46,800 --> 00:24:50,200
Speaker 1: five percent effectiveness rate, he can do that. Okay, you

479
00:24:50,200 --> 00:24:53,480
Speaker 1: should be on that panel. Are you on the pannel? Okay, guys,

480
00:24:53,520 --> 00:24:56,439
Speaker 1: we already talked about some forms of paying for this

481
00:24:56,520 --> 00:25:01,760
Speaker 1: by cutting waste and getting rid of Medicare plus advantage advantage, Um,

482
00:25:01,800 --> 00:25:04,840
Speaker 1: what are some other ideas for paying for this? Because

483
00:25:04,960 --> 00:25:06,760
Speaker 1: you know, Obama said he wasn't gonna sign anything that

484
00:25:06,880 --> 00:25:09,240
Speaker 1: edit is sent to the deficit. And you know, one

485
00:25:09,280 --> 00:25:11,640
Speaker 1: complication with him just saying I'm going to eliminate fraud

486
00:25:11,640 --> 00:25:14,359
Speaker 1: and waste is those aren't scoreable measures according to the

487
00:25:14,359 --> 00:25:17,200
Speaker 1: Congressional Budget Office. You know, it's got to be something

488
00:25:17,240 --> 00:25:19,879
Speaker 1: for them to say, yes, it provides you know, twenty

489
00:25:19,880 --> 00:25:21,919
Speaker 1: million dollars. It's gonna be something the federal government can

490
00:25:22,000 --> 00:25:24,199
Speaker 1: kind of you know, point to as opposed to this

491
00:25:24,240 --> 00:25:27,640
Speaker 1: nebulous cutting cost thing. Um. Obama has been pretty clear

492
00:25:27,680 --> 00:25:29,720
Speaker 1: that he would like to tax people who make more

493
00:25:29,720 --> 00:25:33,879
Speaker 1: than two dollars a year change their tax deductions, and

494
00:25:33,920 --> 00:25:37,000
Speaker 1: that I believe is what the House Plan calls for. Um.

495
00:25:37,040 --> 00:25:40,679
Speaker 1: There's also the idea that we would tax the employer

496
00:25:40,760 --> 00:25:44,960
Speaker 1: plans that are currently on tax the employer tax um

497
00:25:44,960 --> 00:25:47,760
Speaker 1: exemption to get rid of that all together. Yeah, they

498
00:25:47,760 --> 00:25:50,359
Speaker 1: wouldn't be exempt anymore. And there's the thinking, you know,

499
00:25:50,640 --> 00:25:52,520
Speaker 1: this was something that Kine brought up in the presidential

500
00:25:52,560 --> 00:25:54,760
Speaker 1: campaign that Obama poo pooed, which is why it may

501
00:25:54,800 --> 00:25:58,159
Speaker 1: not come back right away. Um. You know, there's the

502
00:25:58,200 --> 00:26:00,480
Speaker 1: idea of people shouldn't have to tax. Why is essentially

503
00:26:00,480 --> 00:26:04,000
Speaker 1: free for them now. But I mean, on the one hand,

504
00:26:04,080 --> 00:26:06,200
Speaker 1: it would be kind of an invisible tax because as

505
00:26:06,200 --> 00:26:08,560
Speaker 1: we say, you already don't know how much your health

506
00:26:08,560 --> 00:26:12,760
Speaker 1: insurance costs um. But also if it's if it's not

507
00:26:12,840 --> 00:26:15,520
Speaker 1: just this free perk that employers can hand out, they

508
00:26:15,600 --> 00:26:19,119
Speaker 1: might be more likely to increase your wages, is one thought.

509
00:26:19,240 --> 00:26:21,639
Speaker 1: I mean, right now, a lot of employers can say,

510
00:26:21,680 --> 00:26:23,680
Speaker 1: this is your salary, but look at this great health

511
00:26:23,680 --> 00:26:26,240
Speaker 1: care plan you don't have to pay for. Whereas when

512
00:26:26,280 --> 00:26:29,359
Speaker 1: that becomes an actual cost to a person, then you

513
00:26:29,359 --> 00:26:31,679
Speaker 1: would weigh that a little bit in more in relation

514
00:26:31,760 --> 00:26:33,719
Speaker 1: to the money in your pocket, so we can all

515
00:26:33,720 --> 00:26:36,320
Speaker 1: look forward to raises it's cost. I mean, that's just

516
00:26:36,359 --> 00:26:39,679
Speaker 1: one thought behind behind this idea. But other people are like, no,

517
00:26:39,720 --> 00:26:42,439
Speaker 1: that's a tax. I don't want it. So then another

518
00:26:42,480 --> 00:26:44,920
Speaker 1: proposal is to flip that tax and tax the insurance

519
00:26:44,920 --> 00:26:48,119
Speaker 1: companies that offer the plans because they're obviously putting a

520
00:26:48,160 --> 00:26:51,080
Speaker 1: pretty penny in their pocket for these tax accept plans,

521
00:26:51,560 --> 00:26:53,359
Speaker 1: and then you know, still kind of rub some people

522
00:26:53,359 --> 00:26:56,159
Speaker 1: a wrong ways. The proposal has been floated just to

523
00:26:56,280 --> 00:26:59,199
Speaker 1: tax um the mega plans, the ones that to have

524
00:26:59,240 --> 00:27:01,879
Speaker 1: spa days. Yeah, kind of like there's the CEO of

525
00:27:01,880 --> 00:27:04,960
Speaker 1: Golden Sax. He's a planet's forty dollars a year, You're kidding,

526
00:27:05,280 --> 00:27:07,240
Speaker 1: And yeah, you always hear him brought up is like,

527
00:27:07,320 --> 00:27:11,200
Speaker 1: you know, does he really need this tax free health

528
00:27:11,240 --> 00:27:14,640
Speaker 1: insurance plans? Golman texts beating in here. We mentioned them

529
00:27:14,640 --> 00:27:17,920
Speaker 1: all the time. They bear the brunt. Ye. So there's

530
00:27:17,920 --> 00:27:19,760
Speaker 1: the thought that maybe we would at tax either people

531
00:27:19,760 --> 00:27:22,000
Speaker 1: who have those kind of plans or the insurance companies

532
00:27:22,000 --> 00:27:25,080
Speaker 1: that offer those kinds of plans. Um. But you know,

533
00:27:25,160 --> 00:27:27,399
Speaker 1: there's this Time magazine article that found that actually a

534
00:27:27,480 --> 00:27:29,640
Speaker 1: lot of state employees have really good plans too. But

535
00:27:30,400 --> 00:27:32,920
Speaker 1: I think that what people are trying to get at

536
00:27:33,040 --> 00:27:36,520
Speaker 1: is that there's money in these employer tax exemptions that

537
00:27:36,560 --> 00:27:38,480
Speaker 1: we're going to have to look at it. It is

538
00:27:38,480 --> 00:27:42,240
Speaker 1: a possible source of funding. So that's the high points.

539
00:27:42,560 --> 00:27:45,320
Speaker 1: There's some other ones like oh, I don't know, um

540
00:27:45,520 --> 00:27:50,840
Speaker 1: Medicaid paying for family planning services right at the donut hole,

541
00:27:50,880 --> 00:27:56,000
Speaker 1: which we sever the provision where any child born in

542
00:27:56,040 --> 00:27:59,880
Speaker 1: the United States is automatically covered if they don't have insurance.

543
00:28:00,400 --> 00:28:03,600
Speaker 1: Stuff like that, Uh, we're not going to cover any

544
00:28:03,640 --> 00:28:07,440
Speaker 1: of the raucousness surrounding those and this one. As a

545
00:28:07,480 --> 00:28:09,040
Speaker 1: matter of fact, I think we've reached the end of

546
00:28:09,040 --> 00:28:12,280
Speaker 1: this one. Guys, Um, Molly, thank you very much for

547
00:28:12,320 --> 00:28:14,920
Speaker 1: coming in. We'll see you in the next one, and

548
00:28:15,000 --> 00:28:17,560
Speaker 1: you'll want to tune in for part three, especially if

549
00:28:17,600 --> 00:28:19,119
Speaker 1: you wake up in the middle of the night with

550
00:28:19,200 --> 00:28:23,120
Speaker 1: your keep clenched shouting you lie, you lie. That's going

551
00:28:23,200 --> 00:28:28,359
Speaker 1: to be about midst truths and lies concerning healthcare reform

552
00:28:28,480 --> 00:28:32,160
Speaker 1: and Obama's proposal, and they'll be criticism from the right

553
00:28:32,240 --> 00:28:34,600
Speaker 1: and the left on the on the plane of that one. Right, Chuck,

554
00:28:34,760 --> 00:28:38,480
Speaker 1: what about the center? The center is just staying mute

555
00:28:38,680 --> 00:28:42,000
Speaker 1: and yeah, okay, So stay tuned for that. That's part

556
00:28:42,080 --> 00:28:45,560
Speaker 1: three in our special four part Healthcare Suite series, brought

557
00:28:45,640 --> 00:28:52,080
Speaker 1: to you by how stuff works dot com. For more

558
00:28:52,120 --> 00:28:54,400
Speaker 1: on this and thousands of other topics, is it how

559
00:28:54,440 --> 00:28:58,160
Speaker 1: stuff works dot Com. Want more how stuff Works, check

560
00:28:58,160 --> 00:29:00,320
Speaker 1: out our blogs on the house stuff Works to come

561
00:29:00,360 --> 00:29:05,680
Speaker 1: home page, brought to you by the reinvented two thousand

562
00:29:05,760 --> 00:29:07,880
Speaker 1: twelve camera. It's ready, are you