Dan Carlin (0:00)

Today's show is sponsored by audible. Go to audible.comdancarlin and get a free 30 day trial membership when you sign up. It's Common Sense with Dan Carlin. I want to start today's program off by talking a little about a guy who was a friend of mine that I'd never met. Like all of you practically in the modern world. It's crazy when you think about how different it is. We all have friends that we've met or made online somehow. Message boards, discussion groups, social media, blogs, you name it, back in the day. And the analog version of that is something like chain letters to pen pals or something, but not uncommon. My kids take it for granted that that's how it's been since ancient Egypt. So I mean, it's normal to have friends you'd never met. And there's a core group of people that used to be on our old discussion board back in the day when that was something kind of different and unique and you needed something like that. And I only know most of these guys by their Internet handles. I'm not sure I would know them. If they introduced themselves to me using their real name, they could sit down in a restaurant next to me. I probably wouldn't know them, but by the handle that they use. These are people I've had long discussions with and sometimes people have gone through deep emotional things and I feel emotionally close to the Scott Dolan's. I hope that's not his Internet handle. Maybe his name's David Smith, but Scott Dolan, Spinney and Exposno and DB Trek and Smitty and I mean there's a bunch of those guys. And Scott Dolan had taken to calling everybody brother this or brother that. Like we were a bunch of acolytes and some sort of weird politico Martian monastery somewhere. And so everybody was Brother something. And the guy we call Bro Dupe died back on February 18th. I guess his real name was Nick Dupree. So Brother Dupree, Bro Dupe. And Nick was an amazing man. Many of you knew Nick. I mean, you can go Google his name and read news articles about how amazing a guy he was. It was quite a long period of time after I'd started interacting with Nick and reading these long walls of text where he would argue passionately about especially healthcare related issues. But everything under the sun took me a while before I think either Nick or somebody else told me Nick is typing all of these characters on the screen that you read one at a time with his thumb, which is One of the few parts of him that moved using a trackball on special software. Nick was totally disabled, had a ventilator, confined to a wheelchair, and did more with his life than a lot of able bodied people do. A lot of so called able bodied people would be proud as heck to have their obituary include what a guy who didn't even make it to 35 years old and was dealt a tough hand in life, what he was able to do. Remember, it's not about the hand you're dealt, but how you play it. And I remember going to a funeral for somebody once where he was in the same circumstance in terms of just having been dealt a tough, tough hand in the game of life and played it magnificently. And the guy at the funeral just said bravo. And I think that's how I feel about Nick. He's just bravo. You did it better than any of the rest of us could do it. Thank goodness. I've never been challenged like that. Well, in honor of Nick, today we're going to talk a little healthcare. Right now. As many of you are aware, one of the big issues going on in Washington D.C. is the repeal of the Affordable Care Act, Obamacare, as the Republicans like to call it. A Trump promise, a Republican promise. And so they're on Capitol Hill trying to do this and it's proving difficult. And I think without wanting to put words in his mouth, if you look at one of these entitlement hawks like a Paul Ryan in private, I bet he would say something like, well, of course it's difficult. This is why we didn't want it to last any longer than this, entitlements get started. Once people feel like this is part of their birthright, you know, free healthcare or whatnot, you know, no exclusion for preconditions, government putting limits on costs and premiums and all that, once people get used to that, you'll never be able to take it away. It'll be like Social Security, which of course as you all know has a nickname. The politicians call it the third rail of American politics. Cause if you touch it, you die. Don't need any more third rails of American politics, right, that are gonna be really expensive. So let's get this ob care out of there before the whole idea becomes an entitlement. Meanwhile, people are starting to realize that with all its problems and it has a bunch of them and they're built in and they're like Greek tragic flaws in Greek theater. They're there, they're going to bring it all. I mean, they're ruining the there's a lot of good things people point to, but there's a lot of things that need work and there's a lot of reasons, and we pointed them out at the time, why the way the Affordable Care act was done was preserving, you know, the part of the system that's part of the problem. Nonetheless, there are some things it does that have been really beneficial and those are the things in large part that the Republican repeal would take away. Right. You're not getting rid of the parts that people really don't like about this as much as you're getting rid of the parts that will kind of help. But they are, you know, onerous on private business. That's going to turn out to be some of the problem though, folks. But listen, if we want to start talking about healthcare reform, allow me to throw in a few thoughts, if you would. The first one is all ideology aside. If I sit you down in a room and we'll just say that you're an efficiency expert, you're an efficient person, I can give you a household budget and you can go through it and figure out how to turn something that's in the red, in the black cut here, get a better deal on that there. All these kinds of things. You're an efficiency expert and I'm going to sit you down and I'm going to throw some cold hard facts at you and I want you to draw some conclusions, if you can, from these facts. Now, understand numbers like the kind of things I'm going to throw at you now, especially comparing over country to country, there are variables involved. Different peoples are different, they eat different foods, they do different things, lifestyles are different. So there's variables. You have to understand that. That's why close comparisons are difficult. But when comparisons are hugely one sided, you can throw the variables out the window and you can draw some conclus. If you wanted to compare the US system and there's a number of countries that are considered to be comparative comparison worthy with the United States system. So I went online, looked at a bunch of different sites that were comparing and contrasting. There are some good, highly sourced numbers from a bunch of these places. But start with the Commonwealth Fund, which is a group that promotes healthcare. So I mean they have an interest in pointing out the problems in the system. But the studies are well sourced and all that kind of stuff and they're sobering. If you haven't looked at the healthcare numbers for the US Compared to other countries, you ought to do that before you even discuss the issue because somehow that needs to be explained away, dealt with. You can't sweep this under the rug. Start with a few facts. The first fact is sobering in and of itself. And I took this quote directly from the website because the US compared to the other countries in our category, is the only one without, you know, a government healthcare system. Right? So theoretically they should all be spending a lot more of public funds on healthcare because, you know, we do it privately more than they do. Right. Here's a quote though, from the website. Quote. Even though the US is the only country on the list without a publicly financed universal health system, it still spends more public dollars on healthcare than all but two of the other countries on the list. That's stunning. Right? In other words, only two of these countries, all of the government healthcare countries, spend more public money, public money on healthcare than we do. And we don't have a government healthcare system, not a universal one. We obviously have a patchwork of things. Medicare, Medicaid, all those kinds of things. The other countries, by the way, that are considered to be comparable to the US for the purposes of this intro, Australia, Canada, Denmark, France, Germany, Japan, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom, okay? In the year 2013, which was obviously before the Affordable Care act took effect, and even now the numbers, you don't have enough numbers on it over time to, to get good looks at what it's changed, but it hasn't changed the basics, I think. And I mean, coverage numbers will be different and that will lead to other realities. But these broad numbers are probably still pretty accurate. In 2013, the US spent a bit more than 17% of GDP on healthcare. 17%. And of course that means nothing unless you know what other countries spend. Right? How does that stack up with the other nations on our comparison list? Right? Well, 17% of GDP is number one on the list. USA. USA. USA. Right. Number two on the list was France at 11.6% of GDP. Right. 50% lower. So the distance, like I said, variables sometimes can come into play, but when you're 50% higher than the next competitor, the variables just fall away. Something's wrong with that number. Right? France spends 11.6% of GDP on healthcare. The UK spends 8 point. This is 2013 numbers. 8.8% of GDP, folks. That's half. That's half what the US spends. If I'm sitting you down with a piece of paper and I'm going to throw a bunch of numbers at you and ask you to draw some conclusions, the first one is that, what do you make of that number. Now add to that what Americans privately pay for healthcare, right? The insurance premiums that come out of your pocket, that's all part of the overall healthcare costs, right? It's not a government expense, it's a you expense, out of pocket stuff, co payments, all that stuff. Right. How do we stack up? Well, you know, it's not going to be good because we're the only one on the list without a universal healthcare thing as part of their system. But, you know, let's see what the numbers look like. The US towers over the number two competitor in this category as well. Canada, by the way, is the number two with the highest insurance premiums, out of pocket expenses, co payments and all that stuff. But Americans spend five times more than our friends north of the border. So we in the US spend five times what the number two country on the list spends. Again, the variables that you could say, well, Americans do more of this or less of that doesn't come into play when it's that big. Again, if you're just working on a few numbers that I give you, that's the second one. What do you make of that? So what are we getting for our money? That's a good question, isn't it? You go and you look at the list and of course the healthcare professionals all have a bunch of different stats that they use as part of an overall panel of assessment to determine how a country's doing. And it's the standard stuff we see everywhere, infant mortality, life expectancy and whatnot. Right. And on that list we don't do very well either. So these countries that are spending dramatically less are scoring higher than the US in most categories. In some categories they are running away with it. Compared to the US The US does pretty well on cancer care, though. Let's point out where things are good. These, of course, as I said, are 2013 numbers I'm using. Newer numbers are going to be slightly different. But the point overall is that if you're going to spend that much more money, one would hope for a corresponding rise in what you're getting for the cash, right? But if you are spending so much more than your competitors and they're actually delivering more in results, again, you're the efficiency expert with the piece of paper and I just give you a few numbers to work with. Plug that into your equation and how does that mess with your thinking? Right? So you might say, well, wait a minute, all right, well, what's different? Start looking at specifics, right? If we got these different cost disparities, what's going on, Right? So the first thing you may look at is, all right, well, let's look at the stuff that this money buys, and let's look at what we pay for it versus what these other countries pay for it. And this turns out to be rather interesting. Take for example, heart bypass surgery. Just an example to show the rule that procedures are a lot more expensive in the US Than in any of the other countries on that list. And again, allowing for variables is fine, but 40% higher in terms of the cost of the surgery than the number two country on the list. So the US Is exceeding the next highest competitor by a ton in all these categories. Average cost in 2013 of heart bypass surgery was listed as 75,000 doll. The second highest on the list was Australia, where it was $42,130. Boom. Okay, there's a prime suspect, right? Procedures are more expensive in the U.S. okay, we'll put that aside now. What else? Well, didn't turn out to be visits to the doctor because these other countries generally had their people going to the doctor more for checkups and routine visits and what have you. US folk in general saw the doctor quite a bit less. So it's not going to doctor visits. It also is not because Americans get hospitalized more and that costs more because the Europeans were actually going in the hospital more, maybe having procedures done or whatever. And by the way, I should point out, because I can hear the Europeans grumbling in my ear from here, that if you go to any of these countries on the list I just mentioned and start talking about the government healthcare system, you're going to hear gripes, because that's human. Took me four months, and then they did this. And, you know, I mean, you hear it anywhere in the world. Everywhere in the world, okay? For most people, not all people, but most people. The problem is, if you want, for comparison purposes, offer them a trade, go to any of these countries after you hear how long it took to get that knee replacement surgery done and say, well, listen, want to trade with us? I've never met a person who didn't say, oh, no, no, I'll stay with what we have. I want it to be better, but I'll stay with what we have. In other words, they're cool. They like it pretty well. Americans in general don't feel that way. And I'll get into why in a little bit, but it's based on experience, because ideologically, Americans want to like the system where the government stays out of healthcare. They really do want to like that the problem is experience differs a little bit. And we'll get to that in a second. Okay, so the list looked at, if it's not hospitalization and if it's not visits to the doctor, in other words, use of those healthcare services, if they're using it more and still paying less, what's going on. And of course, that might account for better health. Well, Americans apparently get more tests and especially the high end ones. We get more MRIs and CAT scans and PET scans and those kind of things. And that costs obviously a bunch of money. But we do more of that than our European and Pacific Rim competitors in healthcare comparison nations and more than our friends north of the border. Also, pharmaceuticals. Americans use more of these medications. I think New Zealand tied us on one of these. So congratulations, New Zealand. But more of the pharmaceuticals than the other countries. And we pay more for them. And again, the distance between what we pay and the number two on the list is so considerable that your eyes bug out a little bit. Once again, if you're working with your little piece of paper, you're the efficiency expert. I'm giving you these facts. And now you need to look at this and try to form some sort of pattern as you look at these numbers and tell me what it means to you. Okay, we are spending a fortune on healthcare and we're going to. I mean, let's disabuse ourselves of the notion that the government doesn't have to spend a fortune on healthcare. That there's some way you could go in terms of a policy and get this giant load of costs off the government's back. You're not gonna do that. So we're discussing a bunch of different ideas that are all gonna cost a fortune and are all gonna increase in cost over time. Bingo. Accept that reality. Now we can have a discussion over which way you prefer to do that. Because it's pipe dreams to think you're gonna be able to get that number down without having so many people fall through the cracks that it's a combination of irresponsible, okay, but also stupid, stupid, because the dirty little secret of healthcare is that the money's gonna come from somewhere. And you are the fountainhead of where money comes from. At some point, we're not gonna make a lot of money off things like charging tariffs to other countries. So by and large, when stuff has to get paid for, it's gonna be you that gets milked for it. Because that's the fountainhead of money, okay? It's taxpayer dollars. Eventually they pay for everything. Either publicly or privately. And when somebody's denied Medicaid because we make an adjustment to the levels that say, you know, you qualified for it yesterday, but we raised the minimum number required. And now you don't get Medicaid, but you still can't afford private. So you end up in an emergency room with some terrible thing someday. And the law says you have to be treated. And, you know, we don't want to change that, do we? I mean, if people are dying, letting them die on your doorstep of a hospital, it just doesn't look right. So you treat the person and then the hospital has to raise, you know, what they charge other people when they go in for procedures or medicine or cancer treatment or whatever, all of a sudden the aspirin costs more because we're covering the cost of people that came here almost dying on our doorstep that had to be treated because they weren't being treated with public money elsewhere. In other words, somebody's paying for all this stuff one way or another, and the only people that ever pays for anything are the taxpayers. You can give it to the government or you can give it to the hospital, but you're paying for people's health care whether or not you deliberately give it to them. Once again, if we accept that premise, it becomes a little bit easier. The Republicans are playing with to age old strategies. And this is part of what makes me so against what they're doing, is that I still have a soft spot in my heart for the idea that there might be ways to invent doing things that have not been invented before. I hate those conversations where everybody assumes, for example, we'll talk about government types, for example. And I will hate when everybody just assumes that every kind of government that will ever be invented has already been invented and the choices are only between those things obviously evolve and new things happen and new possibilities and new ways get tried. And I'm open to that idea. So if people want to talk about a radically new way to try and improve our numbers in any one of the categories I just mentioned, I like those ideas and my ears are open. But when you throw at me the same two things that I've heard a million times that I know is not going to improve healthcare because we've lived that already. And it's the Republicans are talking about tax credits, which the Obama administration does too. I hate that. First of all, if you think about the poor people going to their accountant to make sure they take advantage of their tax credits, I mean, you already see how ridiculous this is for some People. Second of all, it takes an already byzantine tax code and doubles down on the Byzantinism. Byzantinism. What would you say there, Ben? It's not even an adjective, but I just made it one. But you get my point. The more you do this, the more taxes become impossible and you have a thousand loopholes for people to exploit. The other idea, of course, is one we've heard about forever. It's the zombie idea that gets resurrected all the time. It's the idea when you're talking about Medicare or Medicaid or any one of those kinds of programs, that instead of doing the financing out of Washington on those things, you give a block grant to the states instead. So based on the population or what have you, any number of different formulas, these states get a set amount of money, and the way that they sell this idea is that it's flexibility on the ground, and these people will know their individual needs. They'll get this amount of money. They'll be able to direct it in the best ways. It's going to be more efficient. It's going to reach the people. It's an old kind of canard, because it doesn't really work that way. What it really works out to be is a changing of who it has to be that cuts off poor people from people at the federal level to officials in the very various states when they have to tell the people in those communities, I'm sorry, the block grant from the government just ran out. There's no more money. The federal government can't really plausibly do that because they're basically able to write a check and everybody understands it. You can't sit there and go, I'm sorry, the federal government doesn't have any more money. You can try, but it won't work. The states can really do that because in their case, it's really true. So this is just a way to put a cutoff point on the money and then say, when there's no more money, it's your job to tell those people that you're cutting off services or they can't have what they need. That's a kind of a passing of the buck when you think about it, under the guise of increasing local flexibility and efficiency. Lipstick on a pig. I'm not sure you're fooling very many people with that. It's not a new idea, so it's hard for me to get excited about it. We'd be better off, ladies and gentlemen, and it would sure be easier to track the money. And you could get rid of all these things like making people have to sign up for healthcare, even if they're young and healthy, because otherwise the government will hit them with a huge penalty. You'd be better off having a dedicated tax fund. You really would. That just said, listen, all the money from this tax goes into this fund. That fund covers the cost of people walking into any doctor's office whenever they need to and getting treated. One, you'd be able to track the money. Two, you could get rid of all the onerous requirements. And you're probably thinking, that's the last thing I want, Dan. More taxes going to some other cause, to the rat hole that is government and everything else. But if these other countries results are to be believed, if you can pull this off the way they pull this off, your overall costs, at the end of the day, when you sit down and figure what you have left over versus what you paid out over the year, you should be ahead, because every one of those countries is ahead of us. Now, here's the problem, folks. The problem is we keep focusing on something called health insurance. And you know, the Republicans will use a great little weasel phrase. Watch the weasel phrases at all times from all politicians. But the weasel phrase in this whole healthcare reform cycle we're going through now is access to insurance. Right? We will make sure people have access to insurance. Access to insurance doesn't mean, Jack, okay? People don't need access to insurance. They need healthcare. Insurance is supposed to be a means to pay for healthcare. Access to a way to pay for something. I mean, there's a reason. There's a lot of steps there. I mean, for example, the Republicans have made noise about keeping one of the very popular things in Obamacare, which is really, I mean, when you think about it, it's something you have to have for a healthcare system really to work. And yet it's something that destroys the idea that private insurance for healthcare is based on. Right? They need to be able to discriminate over the patients they take. Right? This is an agreement. And the agreement is, okay, you're a good risk, we're a good coverage service. We like the odds here. Boom, boom, boom. But if you have to take every risk, even people you would never take before because they're bad risks, well, you have to make up for something like that on the other side. So if the Republicans are going to really keep the mandate from the Obamacare ACA version of the plan that says that insurance companies can't deny you for having preconditions, then they're going to make that up through something else. And it's likely to be taking caps off what people can be charged and making sure that you say something like, listen, just because you had cancer five years ago, we'll make sure that you cannot be denied. You will have access to insurance because the health care companies will have to cover you. Yes, but they can charge you $19,000 a month. So it's there if you need it. You just can't reach it. So watch the weasel words. Now, let's talk about the problems with the insurance companies and all this. And I want to start with a disclaimer. The insurance companies can't really act any other way. It's not like some evil thing. Some people portray them out to be like they've got some actual alignment in Dungeons and Dragons. They're evil. No, they're not. They have rules. And the rules apply to public companies. I mean, you have to try to maximize the return for shareholders who invest in your company. If you don't, the shareholders will sue the board of directors. I mean, this is how it works. Okay? So involving the insurance companies requires us to incorporate that into the model. Now, the way this was always justified by proponents of this idea was that the insurance companies become the reason that there's cost cutting measures and that somebody's watching the store to make sure it doesn't grow out of control and somebody's trimming the fat and somebody's watching out for redundancies and getting rid of things that you just don't need. In other words, to prevent the runaway growth of healthcare costs. The insurance companies had a vested interest because they're trying to squeeze profit margins out of this, trying not to get their profit totally eaten up by their costs. Right. But it hasn't proven to work out that way. As we said, we have the most expensive system by far by several different versions of measurement. And yet this is how we do it. The systems that don't do it that way don't have those kind of costs. So 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? Another problem with the insurance company's involvement that has really nothing to do with them specifically, but it's very likely that they're part of this cost inflation that we mentioned a second ago. I mean, why is everything so much more expensive in the US in terms of medical technology and treatments and procedures? Maybe because insurance pays for them. And remember, when you talk about the money that's in healthcare. You have to look at it from a multi level perspective. Obviously there are doctors and healthcare professionals on the ground, but they're all working with materials from gloves to syringes, you know, the everyday stuff you need, bandages to the high class stuff. I mean, the special drips for this or that disease that cost $40,000 a treatment, I mean, and everything in between. Right. And all of these are provided by firms who have employees and who are also trying to squeeze out profits. But it ends up creat a place where a lot of people along the entire supply chain in the medical industry are having to pull a profit out of each part of each component that they contribute to the whole. I would suggest that that might be the likely culprit and the fact that insurance companies will often pay this stuff, whereas if it was, the government sometimes comes in, as you know, and will say things like, I'm sorry, we're not compensating you for that. You cut 20% off and that's what we'll pay. This is the kind of thing where the cost inflation may be related to a lot of these outlets going, oh, just add an extra 20%, the insurance companies will pay for it. Where if it was Joe blow on his bill, he'd be like, wait a minute, what is this charge? Honey, get them on the phone, call my lawyer. You see what I'm saying? There's an incentive to sort of fudge this and fudge that and add this and there's a service charge and the rust proof undercoating for your car. But it's not beyond the realm of possibility that that goes on. And if it does, it goes on at every level of the food chain, all the components that it takes to make a 21st century, technologically sophisticated healthcare system run. There's a lot of money in it. I mean, how many do you know? Any people that sell medical technologies? That's a very big business right now. And the cost markup is huge. And the money we're talking about is a ton. Now, what does that have to do with patients on the ground getting healthcare? Well, it impacts the cost. And right now in the United States, if I'm the efficiency expert, I'm looking at two numbers specifically. One is that we are paying so much more private public as a percentage of GDP as individuals, and we are getting so much less. I was riding a train in Ireland once and the air conditioner was broken and an Irish woman stood up and said, irish rail is a scandal, American healthcare is a scandal. And It's a scandal because of those numbers. And in my opinion, much of those numbers and the dynamic that causes them are parts of our system that have been a part of our system, you know, since we created the modern healthcare patchwork in this country over the last 50 years. Part of the problem with American healthcare is that it was never devised as a system. We essentially tried to. I always like to call it socialism laundering or socialized medicine laundering. You know the story here it is in a quick, you know, sort of sketch. The United States had no government healthcare for a long time. Like a lot of countries. Germany got one in the 1880s though. I think Bismarck put it into place, one of the really early ones. But the United States was a little late the party on this. And then when it started, it was something that you saw happening in private businesses and stuff. It was like a fringe benefit. If you come and work for Ford and leave your job at Chrysler, the benefits package here at Ford is better. We have a supplementary insurance if you get sick. It was something that companies started offering. And when the need arose in the United States to have this kind of stuff, whether it was for veterans or whether it was for government workers or what have you, they began to look at what was already going on and try to use that. The same risk avoidance measures we see from our legislature today was part of the legislatures back then. And rather than be accused of socialized medicine or communism or any of the things that would have gotten you primaried out in your district or having you lose your. Your shirt in the next election, there were certain buzzwords that were death and socialism and communism were there. So to avoid that, it was much easier to start to encourage these companies that were providing these fringe benefits to do more of it. Right. We can just begin to evolve a system where through tax breaks and whatnot, we essentially launder the taxpayer's money. So it's not government paying for health care, it's government providing tax breaks to companies who then working through private insurers. In other words, just if there's enough st steps in between taxpayer money and payment for American workers for health care, it's not socialism anymore. And then in the 1960s, of course, the Great Society and the additions of all the Medicares and the Medicaids and all that stuff, and you begin to have at the end of the day, the building blocks of some sort of a ramshackle healthcare system. And then over time, and this has been sort of what the reform has been about lately is how do you connect the dots on all these pieces, how do you take the people that have fallen through the cracks and don't have the insurance through their employer? Or what do you do about people who are getting rejected because they've got pre existing conditions and all this stuff? And you begin to try to connect the dots and maybe you have a workable healthcare system that most people get covered by and the government is able to still say, listen, it's not socialized medicine and have it somehow work while, and this is key, while allowing the stakeholders in the system to still make profits. To me, the poison pill in the Affordable Care act was that, and again, in a system like ours, it's understandable we can't pass real health care reform because the stakeholders are so powerful that they can just sort of stymie real change that affects their business. But in order to get the Affordable Care act passed, President Obama had to work with the stakeholders in a way that kept the stakeholders involved enough in the system to continue to keep the problems that we were dealing with going right. In other words, if you have to have the insurance companies sort of sign off on a new health care system before they're going to play ball, and if they don't play ball, you won't get enough votes in the legislature to get your health care passed, well, what happens if the things that they insist upon screw up the ability of the bill to do what it needs to do long term? What if you're forced by the stakeholders to keep the things that they do that need to maybe go away? If you're going to improve upon any of the numbers that I cited earlier, There's a lot of things insurance companies can do if they're not in the healthcare business. Auto insurance, life insurance, homeowner insurance. They can sell supplementary insurance, which in a lot of those countries I mentioned earlier, you could buy private insurance to go on top of your public insurance. But the public insurance is there or the public health care. See, it's not even insurance sometimes. Sometimes it's just healthcare. So there's ways for these companies to make money. If we can't figure out a way to both provide healthcare to the American people and guarantee the profits of these health insurers, rather than worrying about doing both, a real plan for reform would probably cut them loose and say, we can't keep you happy. You can't work with what we're going to make you work with here. Maybe it's just better if we both part ways. Now, for those of you who are saying, what have you got against health insurers Dan, you're saying, I like my health insurance company. They've done a good job. Let's go back a little bit and talk about the problems that American people have, what they want from their health insurers and how it tends to go instead. I'm going to speak now as a person who has bought a lot of insurance myself. I have a family, I have no employer who pays for my healthcare costs. So I do this as an individual and I've been doing it for years. There's a lot of things I've learned and I'm reasonably intelligent. I'm pretty good at reading the fine print and all this what a person like yours truly wants. I consider myself, you know, middle class person. Here's what I want when I buy this insurance. I want to make sure I'm covered if disaster strikes. Right? Do I like having the doctor visits paid for? Is it nice to have a flu shot that I don't have to cover out of pocket, whatever it might be? Yeah, that's all great, but the main thing I need as a middle class person buying this insurance is to know that if the worst happens, and my goodness, ladies and gentlemen, the worst will happen. This is not about, you know, meteor striking or tsunamis hitting. This is about when a family member gets so ill it's going to cost a fortune. Disaster is when you have to declare bankruptcy because something like that happens. I'm buying insurance to avoid that. And don't minimize the number of people that have to declare bankruptcy in the United States due to medical reasons. A lot of times it's because they can't afford their percentage of the split. I mean, maybe the Insurance companies cover 80% and they only cover 20, but the 20 is still a fortune. Sometimes before the Affordable Care act, and this is what you have to be careful of, that it doesn't go back to the way it was before the Affordable Care Act. A lot of times your insurance policies had medical caps and maximum limits, either annually or for the lifetime of the policy that said that no matter what happens, this policy won't pay out more than $900,000 or a million dollars or even $2 million, which sounds like a lot of money until you're in a car accident and you're a paraplegic or until dad has a stroke and needs long term. I mean, it just goes on and on. Cancer, my goodness, that'll eat up everything. Now you may say, listen, Dan, the government cannot protect people from things like having some cost come up that's so expensive. That they can't pay for that it sends them into bankruptcy. I mean, my goodness, why not just say nobody can fail? It's not like that though, folks. This isn't like some tragedy that strikes, as I said, like a meteor or a tsunami. This is an inevitability that you're going to get hit with these costs. Now, I was always taught, and this is a typical American attitude from mid 20th century, and that's that what individuals can do are best left up to individuals. And what the individuals can't do is when you start saying, well, that's what we enacted a government for, to do for us collectively what we can't do individually. There may have been a time, and there may not have been a time, but there may have been a time when medical care was something that you could envision paying out of pocket reasonably. But the costs of treatment, the amount of treatment we all get compared to the old days, the sheer fact that we're living longer but can almost assuredly then count on increasing medical needs as time goes on, all of these things have changed the landscape so much that we have a shared problem, right? Americans have a problem with affording health care in a way that assures that they're not going to have their lives destroyed when something as common as an expensive family ailment hits them or multiple times hits them. In other words, before the aca, you heard crises stories all the time. I mean, Americans were reaching a breaking point with their system and you could tell because they've never been ready to embrace like they were ready to embrace some sort of government healthcare system as they were when the ACA time period came around. And it was literally based on everything that they lived up to before that point. I mean, take for example, the fine print. Who remembers the fine print? And again, I don't blame the insurance companies for this at all. To me it is just an example of why they are ill suited for this job. What they need to do runs counter to what we need done. But the fine print is so full of loopholes and so hard to understand. It has so many out clauses and ways around things that you never know what you're really covered for until you send the bill in or the bill is submitted and you see if it comes back paid or partially paid or whatnot. That is a level of insecurity that is hard to plan for because you don't know, gee, do I need more insurance on top of this? Am I covered? Can I sleep at night? Because the fine print is endless and the part I always loved. How many of you remember this? The many addendums and updates and changes you would receive in the mail. You get a note from your insurance company and it would just say you'd have this long agreement that you signed and you put in your filing cabinet. You say, okay, well, this is, I don't understand a lot of it, but if I have to, I could take it to a lawyer and here's my agreement. And it seemed like three times a month you'd get a note from the insurance company and it just said it'd be a paragraph of text that didn't seem to mean anything. And it would say, please substitute this text for section 2, page 5, paragraph 3, header C, in your original document. Well, after you've done that a few times, try keeping track of whether or not they're going to cover your kid if they show up with this particular ailment. So it's not quite a runaround because the insurance companies wouldn't look at it that way. They're just doing business the way that they do it. But from the consumer end of it, it has the practical effect of a runaround and you feel like a shell game's going on. Takes all certainty out of what your coverage is and what you bought out of the equation. I guess I would accept that this is the way it has to be more if it's not the way it is in Australia, Canada, Denmark, France, Germany, Japan, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the U.K. in other words, this idea that it has to be this way is once again defied by the evidence. No, it doesn't, because it isn't in a lot of places where we should be for what we're paying, be outperforming in healthcare results. Right? Americans should be better off if this is a pure get what you spend thing than any of those countries. Let's go ask our efficiency experts in government why it isn't. If you're a fiscal conservative, doesn't that just rile you? These socialized medicine countries outperforming the US and outperforming them by a broad margin. What's going on? Don't you feel the need to ask? That riles me as a fiscal conservative. I want answers. I have theories. As I said, I think this is profit bleed along the entire, you know, supply chain in the entire medical industry here. Now, I do want to say once again, you know, if you want to come up with a brand new system that tries to incorporate, I mean, you hear this a lot from the Trump Administration now, right? We're going to open up competition across state lines, let people sell insurance and competition is going to bring down prices. And I mean, we start pretending like that's going to be a magic bullet, but that we're the only country that runs things this way. Why? Because we've got the better mousetrap? Well, the numbers show the exact opposite right now. As I've said many times, I'm fine replacing the Affordable Care act with something better, but it's gotta be better and not better for the stakeholders in the entire healthcare industry because the only stakeholders that should matter, and I'm gonna repeat this cuz I feel this way in a number of different areas. It's a huge problem. The only stakeholders that are the end users, the people you know from whence all the money to pay for all of this ostensibly comes from the taxpayers, right? Not better for all the people in the supply chain so that they can make a profit. And I think the profit motive is wonderful in some areas. For example, I've been convinced for many years that the United States ability and pharmaceutical companies ability in this country to develop new drugs is wonderful. And it is in large part, you know, fueled by the carrot and sticks of the free market. Right? It's a high risk, high reward gig, but it distorts the market somewhat because you have to say, okay listen, if you make this wonder drug, we're going to make sure only you can make it for a while after you initially make it to protect the investment you put in. Okay? But I get that and I think in the end somewhere we're better off for it. But so much of the rest of the healthcare market does not follow the typical free market dynamics that are so often cited. Oh, we'll get competition going in the states and blah blah, blah. Folks, it's not breakfast cereal. It's not breakfast cereal. And that's the problem, okay? Because unlike most goods and services out there, you do not, and most people would simply not be willing to go, for example, for the cut rate doctor, this guy or gal is definitely not as good as the competition, but he's 50% cheaper. So that's who we're going with. Not in that free market. Not if you can help it, not if you can sell the house and the farm and everything else. You're not letting that person operate on your child. You'll give your whole life up and live as a pauper rather than do that. It's not like I'll forego the breakfast cereal because it just is too Expensive right now for lucky charms, you don't save up and cut coupons to get 20% off that doctor treatment. Don't wait for a sale on brain surgery. And it just doesn't work that way. It's a different kind of market. It's a life or death market too. Because of that, trying to say you can fit all problems and solutions into the same template. For example, treating this market, the healthcare market, the same way you would treat a commodity market. It doesn't work that way. And if it did, wouldn't our numbers be lower? Because we're a heck of a lot more free market than these other countries. You may say we're not very free market at all, but we're a heck of a lot more free market than any of those other countries when it comes to their healthcare policies and the way that they deliver it. And ironically, as I said, even with that, we spend more in public money on healthcare than all but two of the countries on that list. What the hell's going on? And once again, I do not want to make these healthcare systems in these other countries out to be panaceas. I'm not saying they don't have problems. I'm not saying they don't make the news for cost overruns or scandals in this and that department. And griping by the people who are the end users. I mean, I think it should be considered to be a fundamental thing that must be present for it to be considered officially a healthcare system, that the end users gripe about its shortcomings. So I'm not trying to make these things have to be a panacea. Just going on the measurables here. The reason Americans have been told that they shouldn't go the route of these other countries is 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. And I don't think anybody would trade their system for ours. So we'll draw the conclusions we can from that. Forget fake news, alternative facts, anything like that. Draw your conclusion from basically that the other thing that drives people crazy, that occurred all the time before the Affordable Care act had to do with pre existing conditions. I've had family members and I myself have been turned down for insurance based on preconditions that almost everybody in the world has. I mean crazy little things where you go, what five years ago, you know, somebody had this infection that everybody gets and what. But we've all been burned by that preconditions thing, it's become an easy out, right? If you don't want to insure somebody, if they don't look like you're going to make money on them in the long term, you just cite a pre existing condition and they're out. And you put in the fine print a lot of times that if we cover you and find out later when it's time for some big payoff that you had a preexisting condition, we can retroactively opt. I mean, the fine print was a killer, folks. And after a while with the lack of consumer protection, people sit there and go, listen. They throw up their hands and just say, I want better protection than this. I don't want to have to get a lawyer out to read this agreement with the health care company. I mean, at a certain point, everybody just says it's got to be easier than this. This has to be a little bit more autopilot for the average American who's got their hands full on other things in life than to have to worry whether they're going to get screwed because of the fine print in their insurance agreement for health care. Right? I mean, people were fed up enough to consider something that was being labeled socialized medicine when President Obama proposed this. That shows you how much Americans had had it. Because that's usually a breach too far for people in this country. But the fact that they were willing to go to it shows how desperate and fed up they were with the way things are. So Republican efforts to keep a couple things from the Affordable Care act but then go back to the way things are is not gonna help, ladies and gentlemen. That's why a lot of these people who have some foresight are already sitting here going, don't put my name on this Republican reform and repeal thing. Trump doesn't want it called Trumpcare, and Ryan doesn't want it called Ryan Care. Because everybody knows what this is gonna do. It's gonna throw people who are not in a great situation now into a worse situation. And one of the places they're gonna get totally screwed is on one or the other ends of this pre existing condition question. Either you can deny people for preexisting conditions, or if you're the insurance companies, you probably have to have the right to charge whatever you want for them. It's gotta be one or the other, because otherwise there's no way to exclude those people and then there's no way to recoup the costs. Especially if the Republicans are going to make sure that you're not required as a young healthy person to buy insurance because that's what that lever was supposed to work for. Right. Compensate for the fact that the insurance companies can't discriminate against individuals with problems or who are older. So, I mean, all these levers were supposed to work together interactively. This compensates for that. That triggers this. And obviously that's how systems work. But if you go and you start breaking individual levers, we'll keep that lever, but we'll get rid of this other lever. Well, it only works when they're all triggering off of each other because this one covers that hole. And so the system will collapse if you take away certain structural supports. And the Republicans are definitely talking about doing that. So when they do that and then the system goes haywire and then they say, oh my God, what did disaster the system is we have to get rid of the things from Obamacare that we didn't get rid of initially. I mean, this preexisting conditions thing's destroying the whole. I mean, we'll see where the money goes, folks. But remember, the reason that we're stuck with the hybrid system that is the aca, the very flawed hybrid system that is the aca, is because the stakeholders who were not the taxpayers were able to buy their legislators and have them insert the clauses and the must haves and the ultimatums into the deal to get it to a point that they would support it. And it's, I mean, there's no other way to put it. It's a poison pill. If you're the insurance companies, for example, looking at this, you win either way. You win if you get the ACA and you know, you get essentially guaranteed profits by the government and all the various things that were put into that, you win. If the ACA becomes too expensive and everybody's mad about the cost and everything and they want to go back to the way things were, well, then you win because you were winning under the way things were. Making sure that no matter what happens, you win is exactly what your lobbyist should be doing for you. If you're sitting down at a strategy session on K Street saying, okay, here's my worry, and they're gonna say, well, listen, here's what we'll do, and either outcome favors you, okay? Again, boom. That's what you pay those people for. If they do a good job, that's what they tell you. If you do a good job working for your insurance companies, you lobby the legislators to do it that way. If you're one of the legislators who gets fat checks from the insurance companies for reelection campaign? You see that it's done that way. I mean, that's how the system works, right? But then that's how you end up with what we have now, a patchwork system with interconnecting levers and gears that don't work very well now, but that if you take them away, you're just going to break an already flawed system. And what are you offering instead? And here's the real question, does what you're offering instead equal better health outcomes for the American people? If you can't answer that question with a resounding yes and explain your thinking right, show your work on the math paper, well then we shouldn't even be talking about reform because you don't have the best interest of the people who actually pay for all of this with their tax dollars in mind. Irish Rail may be a scandal, although I thought it was a wonderful if a little bit warm ride, but US health care is a scandal because of the way those numbers add up on a piece of paper. There's no way you should be doing worse than every country on that list unless you're somehow providing a better service at the end, right? I'll pay more. If we get more, we pay a lot more and we get a lot less. And that's a scandal. It's incumbent upon the people that want to, and I'm using air quotes with my hands fix healthcare to explain how they're going to improve all those things. At the end user side of things, if they say something like we're going to free you from having to buy insurance or getting a big penalty, really is that going to compensate you when you get sick, when you don't have something? That's the problem, ladies and gentlemen. They may say that this benefits you if you're a fine healthy person, but that's a temporary condition. As my dad said, to be so called abled bodied is a temporary state of affairs. And then when you're not, what sort of health care do you deserve? And since it's coming from your tax dollars anyway, let's ask it this way. You're paying into a system that eventually, unless you drop dead, you're going to also use. How nice and comprehensive do you want your care to be when you do? One of the things Nick fought for with Nick's crusade was for himself and for more than 20 other people in his condition to get covered if they stayed at home. So I mean that might even be more expensive than having to go into some Facility somewhere where here's a guy who's already been dealt a tough hand by fate. And you're going to make it tougher by saying instead of being at home with your loved ones, being a part of your family, you're going to be in a facility where they can come and visit you. But most of the time, the people looking after you, making sure you're comfortable, have what you need and whatnot, are employees that sometimes do a good job and maybe sometimes not. Nick was quite vociferous about that sometimes too. Whereas generally in your home, they're more attentive to your needs. And who wouldn't want to think that your quality of life would be better if this was you we were talking about? We were saying you paid taxes into the healthcare system for 25 years before you needed it. Now you've been in a car accident, now you need it. But we want to save money. So I'm going to put you in a medical facility where your loved ones can come and visit you during business hours nine to five. Do you see what I'm saying? Or it might be more expensive, but we're going to get you at home because that's the kind of care you would want. And now that you need it, it's the kind you. I mean, and you may say, Dan, this is rainbows and unicorns, right? I mean, what kind of Cadillac system do you think we're going to have here? I mean, we can't afford what we have now. Okay, understand, I understand that point well as a fiscal conserv. But here's what we have to answer then how do they manage it in these other countries? And even if these other countries don't cover all those things, they cover so much of the foundational things that when you then buy private supplemental insurance in those countries, you can generally up the level of luxury and whatnot considerably if you want to pay on top of that. I mean, and I guess what I'm saying is if we sat down and made a reasonable comparison on a side to side basis and showed most American taxpayers what you get and how the system works in any of those other countries I mentioned to you, and then how ours works, which they're probably pretty darn familiar with, and say, guess what? We're going to give you real freedom of choice. Isn't that what we always say, let's give Americans choice? Okay, well, let's give them a choice between any of these healthcare systems and say, pick the one you want just based on benefits. Do you think they Pick ours. And if they don't, then with what we're spending, it's a travesty and a scandal. And let's hold our legislators accountable to that. And saying we're not exactly sure how you go about it, you may have some ideological blinders that constrain the different methods you can choose. That's fine, but we're just going to lay out what the required results are. You must achieve these things and we don't care how you do it. Come back to us when you have a plan. Now, you may say that's unicorns and rainbows to expect the American system to work that way, but I watched Donald Trump give a speech about what, a week and a half ago, two weeks ago now, it was the one where they said afterwards he really looks presidential because he lowered his voice and read off the teleprompter and watched him basically give a rainbows and unicorns, you know, promise on any number of different fronts, from foreign policy to domestic policy to everything else. And I just, you know, it's funny how often have we talked about this, but one of the things we've mentioned every time the presidency changes hands is how people who were sober, rational, real politic, people who could see things for what they really were when the previous administration was running the show. So all of a sudden, when a person closer to their own political bent got in power, they put the rose colored glasses on and all of a sudden we just hear what we want to hear. They can give you a load of bs, but you don't hear it all of a sudden because you're a true believer and it's your person giving you the BS now instead of the other person. And all of a sudden Trump is sitting there giving you the rainbows and units. It's going to be great health care for everybody. It's going to be such great health care you won't even know how good. You've never seen health care this great. I mean, where are the specifics where you're funding for it? Where's any of that stuff? But the true believers don't care. Just like the Obama people had their rose colored glasses on with that guy, just like the George W. Bush people did, just with their guy, with the Clinton people. I mean, this is, it's so predictable, isn't it? Right? Your person can do no wrong. And who needs details when it's my person giving it to me? I mean, all I've heard from Trump is rainbows and unicorns. So if you say to me my Health care reform plan is rainbows and unicorns. Well, why should it be any different? I've heard that this is going to be the best healthcare plan. We're going to love our healthcare, it's going to be great. So why can't it be either less expensive or better outcomes with more satisfied end users or both? I mean, I didn't vote for this guy, but if he's handing out unicorns, I'd like a candy apple red one, please. I had an interesting thought as I was thinking about how I wanted to talk to you about Audible today, a longtime sponsor of the program. And it was a little bit of a rundown about what book production and the owning of books and the reading of books was like in the Roman Empire's day. And they were talking about the sheer fact that books had to be copied one by one by a human hand, made them rare and valuable items, as you might imagine. Right. It's a labor intensive operation doing it that way. Right. And they talked about how at the time, I remember one of the ways in which people were able to get their consumption of books down when there were so few books is that people would have public readings. And so this rare book, somebody would stand up on a stage and they would essentially read it to an audience of listeners. And I thought, well, you know, that's really a lot like what consuming an audiobook is like, isn't it? It's like the ancient version of the audiobook, the analog version. And of course the improvements since then have been, well, hard to quantify. Right. I mean, just start with the fact that you get it on your iPhone, your iPad, your Android device, your Windows phone. You can download and listen on an iOS device, an Android device, an Amazon Fire tablet, a Windows Phone, like the old fashioned books. But unlike going and listening to the ancient spokesperson read a book to you, you get to own your books with Audible. They're yours. And you have a sort of a virtual library where you can access your books anytime, anywhere, right from your smartphone. Also, unlike, I think the going to the public reading, Audible has something they call a great listen guarantee, where if you don't like it, you can swap it. Try explaining that to the public speaker reading you that rare and valuable book. Audible has a whole bunch of features that I like too. There are things that sort of compensate for what people are missing with the old brick and mortar books. Like you used to be able to read a book and hand it off to a friend afterwards. Well, Audible compensates for that with a send this book feature where you can share a book from your library with anyone. And if it's their first time accepting a book through this feature, they can listen for free. And if you just want to send them a clip, there's a neat part that you like. You can share audio excerpts with anyone. There's also something called whisper sync for voice. I don't know if you recall me talking about this, but you can switch back and forth through all sorts of different mediums. I mean, you can, you can be reading and then switch to listening to the audiobook across a number of different devices, including Amazon's Kindle and Echo, without ever losing your place or missing a word. I mean, these are all things that make the experience of an audiobook presentation really cool and different and really maximizes what the medium can do. Now, what I'd like to recommend to you today is actually something one of your number recommended to me. They knew that I was a fan of books on the Apache Indians and they said, a new one's come out, you should check it out. And I was a little slow on the uptake because I thought, oh, you know, everyone always says these new books and turns out a lot of times it's a lot of the rehash material. But boy, was I wrong. He recommended a book called the Apache wars, the Hunt for Geronimo, the Apache Kid and the Captive Boy who Started the Longest War in American History by Paul Andrew Hutton. And it is good and there's new stuff in there I didn't hear. And there were a lot of things that happened in the history of the Apaches where sometimes the original research is from the 1950s, 1960s, and you think, surely someone has delved into these things and found out new information. Well, they have. On several occasions during the consuming of the Apache Wars, I remember thinking, boy, I'd always wondered about new information on that point. So if you like that subject, and it is definitely above the basic introductory level. So this is for, you know, fans of the Apache story who want to take it to the next level a little bit and are ready for something a little deeper. It was great. I loved it. I thought the narrator was good too. Jonathan Yen did a good job on this, I thought. And so if you'd like to check that out and you're not already an Audible customer, well, go to audible.comdancarlin and get a free audiobook with a 30 day trial membership. If you think the show you just heard is worth a dollar, Dan and Ben would love to have it. Go to dancarlin.com for information on how to donate to the show. You want to help the podcasts? Just buy your Amazon.com products through the Amazon search window on Dancarlin.com it doesn't cost you a penny more and it helps these guys out because they are nice young fellas.