Common Sense with Dan Carlin – Show 314: "Unhealthy Numbers"

Release Date: March 16, 2017

In this compelling episode of Common Sense with Dan Carlin, host Dan Carlin delves deep into the complexities of the American healthcare system. Through a blend of personal anecdotes, statistical analysis, and critical examination, Carlin offers listeners a thought-provoking exploration of why the United States spends more on healthcare than its international counterparts while often achieving poorer health outcomes.

1. Tribute to Nick Dupree

The episode opens with a heartfelt tribute to Nick Dupree, an online friend of Dan Carlin's who tragically passed away. Carlin emphasizes the profound impact Nick had, especially in advocating for healthcare reforms. This personal connection sets the stage for the episode's central theme:

"Nick was an amazing man... He's just bravo. You did it better than any of the rest of us could do it." ([05:30])

This tribute not only honors Nick's legacy but also underscores the human element behind the healthcare statistics that Carlin is about to discuss.

2. The State of American Healthcare

Carlin transitions smoothly from his tribute to the broader topic of healthcare reform, focusing on the ongoing political battle to repeal the Affordable Care Act (ACA), commonly known as Obamacare. He highlights the Republicans' efforts to dismantle the ACA and the inherent challenges in doing so:

"One of the big issues going on in Washington D.C. is the repeal of the Affordable Care Act... And so they're on Capitol Hill trying to do this and it's proving difficult." ([09:25])

Carlin suggests that figures like Paul Ryan, often labeled as entitlement hawks, recognize the entrenched nature of such policies once they become perceived as birthrights.

3. Comparative Healthcare Spending

A significant portion of the episode is devoted to comparing U.S. healthcare spending with that of other developed nations. Utilizing data from the Commonwealth Fund, Carlin presents a stark contrast:

"In 2013, the US spent a bit more than 17% of GDP on healthcare. 17%. ... That's half what the US spends." ([15:40])

He points out that the U.S. is the only major country without a universal healthcare system, yet it spends more public dollars on healthcare than all but two countries with such systems. Countries included in his comparison are Australia, Canada, Denmark, France, Germany, Japan, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom.

Carlin underscores the inefficiency of the U.S. system by highlighting how these countries achieve better health outcomes with significantly lower expenditures:

"If you're spending that much more than your competitors and they're actually delivering more in results, ... how does that mess with your thinking?" ([21:15])

4. Identifying Cost Drivers in the U.S. System

Carlin meticulously breaks down the factors contributing to the exorbitant costs of American healthcare:

• Procedural Costs: He cites heart bypass surgery as an example, noting that it costs 40% more in the U.S. compared to Australia:

  "Average cost in 2013 of heart bypass surgery was listed as $75,000. The second highest on the list was Australia, where it was $42,130." ([24:50])

• Pharmaceuticals: The U.S. not only consumes more pharmaceuticals but also pays premium prices for them, often outpacing even New Zealand in expenditure.

• Advanced Imaging: Americans undergo more MRIs, CAT scans, and PET scans than their international counterparts, driving up costs without necessarily improving patient outcomes.

Carlin posits that the profit-driven nature of the U.S. healthcare supply chain exacerbates these issues:

"The dirty little secret of healthcare is that the money's gonna come from somewhere... it's the taxpayers." ([32:10])

5. The Role of Insurance Companies

A central theme of the episode is the critical examination of insurance companies within the U.S. healthcare framework. Carlin argues that insurance companies, while not inherently malicious, operate under a model that prioritizes shareholder returns, often at the expense of patient care:

"The insurance companies can't really act any other way. They're trying to maximize the return for shareholders." ([38:45])

He critiques the notion that insurance companies effectively control costs and improve efficiency, pointing out that the U.S. still leads in healthcare expenditures without corresponding health benefits.

6. Critique of Repeal Efforts and Policy Proposals

Carlin is highly skeptical of Republican proposals to repeal or replace the ACA, labeling many as ineffective or regressive. He specifically criticizes the idea of providing tax credits and block grants to states, which he believes would lead to increased inefficiencies and cost burdens on taxpayers:

"The more you do this, the more taxes become impossible and you have a thousand loopholes for people to exploit." ([45:30])

He likens these proposals to “lipstick on a pig,” suggesting that superficial changes won’t address the systemic issues plaguing American healthcare.

7. Personal Insights and Consumer Experience

Drawing from his own experiences with purchasing health insurance, Carlin provides a relatable perspective on the pitfalls of the current system. He emphasizes the anxiety and uncertainty consumers face due to convoluted policy terms and the ever-present fear of catastrophic medical expenses:

"I'm buying insurance to avoid that [bankruptcy]." ([52:20])

He discusses the limitations of insurance policies, such as coverage caps and the teetering balance between premiums and actual coverage, which often leave individuals vulnerable despite being insured.

8. Systemic Flaws and the Path Forward

Carlin argues that the U.S. healthcare system has never been coherently designed, evolving instead from fragmented policies and private-sector initiatives. This lack of a unified structure has led to inefficiencies and disparities in coverage and care:

"What we have now, a patchwork system with interconnecting levers and gears that don't work very well." ([1:05:00])

He calls for accountability from policymakers, urging them to base reforms on empirical evidence and the successful models employed by other nations rather than ideologically driven solutions that fail to address core issues.

9. Conclusion: The Necessity of Comprehensive Reform

In wrapping up his analysis, Carlin reinforces the necessity of comprehensive healthcare reform that prioritizes patient outcomes over profit margins. He critiques the short-sightedness of political maneuvering that favors insurance companies and other stakeholders at the expense of the American public:

"If you're sitting down with your pencil and your piece of paper and just the facts I've given you, what do you deduce about that? Now?" ([1:10:15])

Carlin concludes that without fundamentally rethinking the structure and incentives of the U.S. healthcare system, significant improvements in both cost and quality of care remain elusive.

Notable Quotes:

• "Remember, it's not about the hand you're dealt, but how you play it." – Dan Carlin ([07:45])

• "The Americans have been told that they shouldn't go the route of these other countries because it's going to cost a lot more and or you're going to have a worse end user experience. And the raw numbers don't seem to show that at all." – Dan Carlin ([59:30])

• "It's a life or death market... It's not like I'll forego the breakfast cereal because it just is too Expensive right now for lucky charms." – Dan Carlin ([1:02:50])

Final Thoughts:

Dan Carlin's "Unhealthy Numbers" serves as a scathing critique of the American healthcare system, highlighting its inefficiencies, exorbitant costs, and systemic flaws. By juxtaposing U.S. healthcare spending with that of other developed nations, Carlin illustrates a clear disparity between investment and outcomes. His insights call for a reevaluation of existing policies and the implementation of reforms that prioritize patient care over profits, urging listeners to consider the long-term sustainability and fairness of the current system.

Listeners new to the topic will find this episode an illuminating primer on the complexities of healthcare reform in the United States, presented through Carlin's characteristic blend of deep analysis and accessible storytelling.