Health Care Around the World

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Show Notes

Healthcare systems around the world: 

What is a healthcare system? 

1. Providers, 2. Population/People, 3. Insurers 

Insurers:

Health Maintenance Organization (HMO): they cover your care by integrating with the providers (KaiserPermanente) but you still pay them a premium. A set list of doctors that you can see. If you don’t see these doctors, you pay out of pocket. 

Preferred Provider Organization (PPO). You will still get a list but the flexibility is greater. The list isn’t mandatory and the insurance should still cover a portion of it. 

“A nation as prosperous and successful as ours must guarantee the health of all its men and women. Safeguarding healthcare for every American is not a sentimental wish, it’s a matter of justice” Woodrow Wilson (1912 election for president)

The American Medical Association wanted government separate from healthcare back then and still what we have now. 

All other rich countries provide healthcare for all their people and spend half of what we do in the U.S. 

The unanswered question: Why has the richest country in the world never made the commitment to provide healthcare for everyone? 

Utilization of healthcare systems. Regional board or national board to decide what the prices are and what procedures are covered. It’s a rationing program. Over utilization in Britain sets age limits. They won’t pay for dialysis beyond 88-90, but you know the money is going back into the system. In the U.S., the money goes to investors. 

American’s spend more on hospitals, whereas other countries spend less on these types of facilities. They shaft doctors and hospitals in Japan. 

T.R. Reid’s Models and Explanations: 

U.S. strengths: best medical education in the world, most innovative scientific research, and best equipped hospitals. 

Who pays for it and who provides it? 

Beveridge Model: (UK, Spain, New Zealand) (William Beveridge…British man)

Universal healthcare coverage; financed by the government through tax payments and the government owns everything. 

Winston Churchill employed Lord Beveridge to investigate social services. They decided it’s the government’s responsibility to cover everyone. 

Bismarck Model: (Germany, France, Japan, and many other European countries)

Otto Van Bismarck (1871/2 unified Prussia as Germany). He created the welfare state and started to send everyone money from the government. Social security, workman’s compensation, 1881 universal healthcare system through insurance companies. 

Insurance system financed by employers and employees through payroll deductions. Everything is split with the employer. In contrast to the U.S. these insurance companies are non-profit and must enroll all citizens, and the government will step in when someone is unemployed. 

All the hospitals and practices are private practice. Not run by the government. People like their health insurance companies. Insurance companies have to pay doctors within a certain amount of days as well as patients. They have really strict regulation of insurance companies. They also can’t deny claims. 

Unemployed or self-employed individuals do not lose health insurance! Government pays the half of your premium or the whole premium. 

National Health Insurance Model: (Canada, South Korea, Taiwan)

Combines a bit of both the Beveridge and Bismarck model systems where services are provided via private healthcare providers but payments are processed through a government-run insurance program funded via taxes or a premium paid through employers. Limit costs by limiting treatments that are paid for and/or making patients wait for elective surgeries. 

Everyone pays a tax or premium and everyone can go to the doctor for free. They have limited the number of surgeons, scans, etc to save money. For acute care, everyone is treated, but if the medical problem can wait, you must wait. *Especially in Canada

Out-Of-Pocket Model: (Developing countries, only about 50 countries have programs and the rest have this one)

Only those who have money for healthcare can afford to access and pay for it. 

Why is America’s healthcare costs so expensive? 

We employ all of these types of models in various ways for different classes of people leading to a disjointed and costly system. On top of this, depending on where you fall in American society and healthcare providers, you receive different treatment and care. This disorganization of our national healthcare system leads to higher spending per capita and worse health outcomes compared to other developed countries. For example, we don’t go to the doctor as much as other countries for preventative healthcare treatments and with each visit, we pay more. 

To expand a bit about how the U.S. healthcare system employees all of these models, we can take a look a some of the types of people treated in each sector. 

Native Americans, Veterans, Active Duty Military Personnel: The Beveridge Model of healthcare like the NHS in Britain. You never receive a bill for the treatment, you’re treated by government hospitals and employees. Government buys the pills. 

Working person splitting your insurance premium with employer: The Bismarck Model of healthcare similar to countries like France and Germany. About 150-160 million Americans receive care through this route. 

Over 65 and you get insurance through a government run program called Medicare: you are a person experiencing the National Health Insurance Model similar to Canada. More than 40 million American’s are on this model in our system. 

If you’re part of the 30 million uninsured Americans, then you’re like a person living in a developing country in rural Africa, South America, etc. 

So what’s the main difference between us and other countries around the globe? All other countries have decided to pursue one fundamental model. Not a mix of all of these systems and rules and models. 

aOne size fits all medicine. Why would anyone want to do that?

A. Simpler and cheaper to manage (set of rules, prices, etc)

B. Cost and transparency (U.S. idk vs. France who has a charge, what insurance will pay you back, etc)

C. American health insurance companies have the highest administrative costs in the world (18-25% cost to every bill they pay). Canada has a 5% admin cost. Britain has 5%. France has 3%. 

D. Economic incentive for preventive care. U.S. insurance companies pay monthly dividends to investors instead of economic incentives to people buying health insurance. 

Preventive health breakthroughs. Cancer warning on tobacco products. Britain and Europe have made it more successful. 

You must make the moral determination that everyone has access to healthcare and medicine. If you don’t make this decision, those with money can afford to see doctors while the others cannot. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3596027/#:~:text=Reid%20compared%204%20different%20health,out%2Dof%2Dpocket%20model.

How many American’s are not covered by health insurance? 

According to the census.gov statistics, 8.5 percent of people or nearly 27.5 million did not have health insurance at any point during the year. 

https://www.census.gov/library/publications/2019/demo/p60-267.html#:~:text=In%202018%2C%208.5%20percent%20of,7.9%20percent%20or%2025.6%20million).

When people think about socialized healthcare system, I think the United Kingdom comes to mind for me. (BEVERIDGE)

The government runs the entire thing and is essentially the closest model to when someone in the U.S. screams about socialized medicine. Not only is this model overall cheaper, but it provides better health outcomes for people compared to the U.S. 

Let’s talk about some statistics: (The Organization for Economic Co-operation, OECD)

Healthcare spending per person (2018): $4070 vs $10,586

Healthcare spending by percent of GDP (2018): UK 9.8% vs U.S. 16.9%

Life expectancy at birth (2017): UK 81.3 vs U.S. 78.6

Infant mortality per 1000 births (2017): UK 3.9 vs U.S. 5.8

It’s a service you use and never get a bill. Everyone pays into it through taxes so when you need to use it, you can. The more money you earn, the more taxes you pay and the better you contribute to the system. Some services are paid out of pocket like dental, eyes, and some prescription drugs, but these costs are low compared to the US (57% less than the U.S.). Most GPs are contractors with the NHS. They establish contracts with how  much they can earn for services. There is also a private healthcare sector by private health insurance companies and out of pocket spending. Very strong support for the NHS in the United Kingdom and something that all British people are proud of. 

How does Germany’s universal healthcare system compare? (BISMARCK)

Health spending per person (2017): Germany $5800 vs U.S. $10200

Percent of GDP on healthcare (2017): Germany 11.2% vs U.S. 17.1%

Percent of people covered (2017): Germany 100% vs U.S. 91.2% (about 28 million uninsured)

Avoidable deaths per 100,000 people (2013): Germany 83/100k people vs US 112/100k

Life expectancy at birth (2017): Germany 81.1 vs U.S. 78.6

Infant mortality per 1000 births (2017): Germany 3.2 vs U.S. 6.0

Everyone buys health insurance from a private health insurance company and then the hospitals and labs are almost all private. It works better because everyone is covered and required to be in the system. Everyone has to be covered and cannot be denied coverage and has access to the same treatment from any doctor or hospital. 

There are two sectors labeled Statutory Heath Insurance (SHI) and Private Health Insurance (PHI). Germans are only eligible for PHI if they make over 60k per year or are self-employed. Everyone else pays into SHI companies which are all not-for-profit companies where dependents are covered for free and maximum monthly costs are capped at 840 euros per month. SHI companies are heavily regulated by the government in what they can charge, what procedures they can fund, and other heavy rules. Employers share most of the cost for paying into these programs similar to the U.S. However, the government will also pay into SHI for people who are unemployed. They compete for people using small perks. Something like offering bonuses for going to the gym, getting annual check-ups. They’re small vouchers but they ensure people are proactive about their health. 

Some potential issues include concerns about wait times for specialists. But citizens like that they can predict costs and that everyone is covered. Insurance companies have to pay for every claim and can’t deny it. They also love that they can go to any doctor. They have decided to commit to covering everyone. 

What about France? (BISMARCK)

France was recognized as the best healthcare system across the globe by the World Health Organization in 2000 and provides universal coverage at a lower cost with comparable and even better health outcome than the U.S. 

Let’s talk about some statistics: 

Infant mortality per 1000 births (2017): France 3.5 vs U.S. 6.0

Life expectancy at birth (2017): France 82.5 vs U.S. 78.6

French systems gives every citizen health coverage from birth which leads to preventative care. They call it social security. Just government financed but not government run. Doctors are not restricted or hospitals, labs, or clinics. America is the only place where insurance companies dictate where you can go. The system covers about 70-80% of medical costs with the remaining out of pocket. Also has voluntary supplementary insurance provided by private insurance companies. Also legally requires price transparency and no waiting lists for specialist treatment or referrals. 

Healthcare spending per person (2017): $4900 vs $10,200. They keep these costs low by minimizing administrative costs. (must be less than 5%) Carte vitale. An electronic health card with medical records to save time and money. The French parliament sets a social security expenditures to stay within a budget. 

French employers and citizens pay more in income taxes but Americans end up paying more with copays and out of pocket drug expenses. Medical school is nearly free in France vs U.S. cost of medical school. 

What about Canada? (NATIONAL HEALTH INSURANCE)

Can you guys guess the next country? It’s usually characterized by basic universal coverage, cheaper drug prices and reported longer lines?

Single payer healthcare system sort of like the proposed Medicare for all program in the U.S. Let’s review some statistics compared to the U.S. 

Healthcare spending by percent of GDP (2017): Canada 10.4% vs U.S. 17.2%

Healthcare spending per person (2017): $4500 vs $10,200

Out of pocket spending per person (2017): $650 vs $1100

Canada has basic universal healthcare coverage with comparable or better health outcomes compared to the U.S. 

Avoidable deaths per 100,000 people (2013): Canada 78/100k people vs US 112/100k

Life expectancy at birth (2017): Canada 82.47 vs U.S. 78.6

Infant mortality per 1000 births (2017): Canada 4.8 vs U.S. 6.0

Publicly funded model with private providers. Established to ensure health equity among citizens regardless of people’s ability to pay and keeps administrative costs low. The health ministry determined what is covered, what pills will be paid for, which procedures will be allowed. In the U.S., these are decisions made by individual insurance companies in the U.S. Canada values equity so everyone receives the same care. Medicare in Canada does not cover everything though. Things like dental, mental health, etc. can be covered by supplemental private insurance through employers. However, they can’t use private insurance to cover things that are covered under the government plan. 

What are some problems? 

Longer wait times for Canadians within 48 hours, to see specialists, and elective surgeries. Flooded emergency rooms because private care practices do not have out of regular hours. Not all things are covered including most prescription drugs that need to be paid for out-of-pocket. Some social drug programs or province specific help for certain age groups. Per capita out of pocket spending on prescription drugs was about $670 vs the U.S. $1000. 

The model needs some reform, but Canadians are still very proud of their healthcare system. They know it’s still better than the U.S. system. Lower costs, higher health outcomes. 

One system is the solution: 

ASIDE: 

We don’t have a set price list of how much the bill will be. We need a master price list. The thing about a single payer healthcare system in the U.S. is that lobbying groups and healthcare companies can set those prices making a single payer system just as expensive as what it is right now. One system allows you to create a transparent cost and charge schedule. 

One potential solution is to expand Medicare for all covering all adults 65+ and 18- and allowing adults to buy in to it. It would maintain coverage at many participating hospitals and allow for easier access to healthcare options. Might not reduce costs immediately. 

Transcript

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hello everybody and welcome back to

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another episode of how did we not know

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that

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i’m nat i’m jack and i’m esteban

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yay hi everyone today we have a very

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special guest it’s my very good friend

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esteban and he will be presenting on

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healthcare around the world right that’s

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right yeah

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talking a little bit about different

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healthcare systems across the globe and

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especially something that’s like

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relevant to the united states as well so

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okay yeah so i guess um we can start at

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the very beginning for people who don’t

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know

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sort of what a healthcare system is um

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so

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uh just doing some basic research and

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sort of my own background knowledge

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uh so healthcare system really is

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composed of really three things and so

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first you have providers

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or medical providers who are actually

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providing your care the second is really

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the population of the people who are

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taking advantage of that care

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and then three is really insurers or

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who’s paying

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for uh your health care um so those

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those three things really make up

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a comprehensive health care system and

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um

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i guess something off the bat that

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people might be familiar with seeing on

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health insurance cards um are the

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abbreviations hmo and ppo

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um so in the united states we have um

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those two abbreviations for insurer

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providers

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uh but i can just sort of go into the

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the basics of what those two

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uh differences mean um so

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uh if you’ve ever seen hmo written on

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your health insurance card it really

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stands for health maintenance

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organization

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um and so they actually uh cover your

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care by integrating with

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uh private providers so an example is

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like kaiser

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uh an insurance company but you still

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you pay them the premium

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and they sort of like give you a set

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list of doctors that you can see

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but if you don’t see these doctors you

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have to pay out of pocket for your care

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um and then the other sort of big

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insurance type of company

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in the united states is a preferred

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provider organization or ppo

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um so you still get that list of doctors

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that you can

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try to see but your flexibility is

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greater so the list isn’t

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mandatory and the insurance would still

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cover a portion of it if you do decide

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to go to a physician that’s really not

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on their list of

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of doctors so those are really like to

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the big differences in the insurer types

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that we have in the united states and

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what composes our own health care system

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so it’s just a brief introduction

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okay um with like the ppo versus hmo

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when you get to decide which type you

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have is it just based on what your

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employer chose for you

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great question yeah and i think it’s

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really based on

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um what your employer is willing to pay

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or help pay the premium for

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so i think it really depends on employer

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but also i mean if you’re self-employed

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or

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even unemployed and looking for health

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insurance um these are two

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two different types that you might see

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so what is medicaid under is that gonna

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be hmo or ppo

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oh my gosh that’s a good question i

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don’t know probably ppo right because

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yeah so actually these are i think more

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relevant to

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um insurance providers so like medicare

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medicaid is actually

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something that we can get into a little

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bit in the future of talking together

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because

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that’s almost like a completely

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different model of providing healthcare

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so these are really like

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insurance companies provide care right

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uh

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and pay for it um sort of the connection

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between the people and the providers

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but medicare and medicaid are sort of

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related directly just to the government

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so the government is the one actually

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paying

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not the insurance company okay so then

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is this unique to the united

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states health care system yeah great

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question so

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uh we can talk about some

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models that i’ve read a lot about in the

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new book uh

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that i recently read called the healing

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of america by t.r reed so

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he gives a great sort of overview of

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different healthcare systems across the

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globe

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but no this isn’t really i guess unique

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to the united states like there are

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definitely insurance companies in other

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countries

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and we can talk about how they’ve sort

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of integrated that into a healthcare

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system and model for their own countries

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and how it works

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oh yeah i mentioned uh the book the

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healing of america by t.r reed

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um and if if you look up tr read on

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youtube i mean he’s a great sort of

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speaker about health care systems across

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the globe and and really

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sort of helping you gain a better

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perspective of what you think is the

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best choice for

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america going forward but he started one

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of his recent videos that i watched with

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a quote from

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a president who won election and the

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quote goes

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a nation as prosperous and successful as

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ours must guarantee the health of all of

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its men

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and women safeguarding health care for

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every american is not a sentimental wish

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it’s a matter of justice and you may

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think that that sounds like

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a presidential candidate that i mean

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should should have been

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in the running really recently but that

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was actually said by woodward

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woodrow wilson in 1912 um in his

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election for president

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so it’s like not common that i mean

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sorry not uncommon that um

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americans have sort of been vying for a

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health care system that covers every

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single person

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um in trying to recognize that it’s sort

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of a moral dilemma that everyone

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deserves access to health care

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um but there are a series of uh

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different associations that have sort of

0:05:07.360,0:05:11.039
hindered that over time in history and

0:05:10.000,0:05:13.360
one of those

0:05:11.039,0:05:14.160
um has been really the american medical

0:05:13.360,0:05:15.759
associate

0:05:14.160,0:05:17.440
association wanted government sort of

0:05:15.759,0:05:19.600
separate from health care back then

0:05:17.440,0:05:21.039
and so it sort of snowballed into what

0:05:19.600,0:05:22.720
we have now a little bit more of that

0:05:21.039,0:05:24.639
separation

0:05:22.720,0:05:25.759
but i guess what he he talks about a lot

0:05:24.639,0:05:27.600
in his book and

0:05:25.759,0:05:30.080
some like of my own opinions on it is

0:05:27.600,0:05:30.479
that um all other rich countries in the

0:05:30.080,0:05:31.759
world

0:05:30.479,0:05:33.680
provide health care for all of their

0:05:31.759,0:05:35.919
people so everyone is covered but they

0:05:33.680,0:05:37.600
spend half of what we do in the u.s

0:05:35.919,0:05:38.960
um and so the unanswered question is

0:05:37.600,0:05:40.320
really why has

0:05:38.960,0:05:41.600
the richest country in the world never

0:05:40.320,0:05:42.639
made the commitment to provide health

0:05:41.600,0:05:44.479
care for everyone

0:05:42.639,0:05:45.919
i mean i think that’s what a lot of

0:05:44.479,0:05:47.360
voters who um

0:05:45.919,0:05:48.880
prioritize health care is one of their

0:05:47.360,0:05:49.759
their main voting issues today in the

0:05:48.880,0:05:51.280
united states

0:05:49.759,0:05:54.000
um is worried about and wants to know

0:05:51.280,0:05:56.240
more about um so

0:05:54.000,0:05:58.319
i guess i can go over an overview of

0:05:56.240,0:05:59.840
sort of tr reads models and explanations

0:05:58.319,0:06:01.520
because it’ll help explain a lot about

0:05:59.840,0:06:03.120
how other rich countries

0:06:01.520,0:06:04.720
around the globe are dealing with health

0:06:03.120,0:06:07.520
care systems

0:06:04.720,0:06:08.000
but i guess to start off is the us is

0:06:07.520,0:06:09.600
definitely

0:06:08.000,0:06:11.120
sort of on the top in terms of strengths

0:06:09.600,0:06:13.039
with uh we’re able to

0:06:11.120,0:06:14.880
provide the best medical education in

0:06:13.039,0:06:16.639
the world uh we have some of the most

0:06:14.880,0:06:18.479
innovative scientific research and

0:06:16.639,0:06:19.199
development of new therapeutics in the

0:06:18.479,0:06:20.560
world

0:06:19.199,0:06:22.880
and we have some of the best equipped

0:06:20.560,0:06:24.160
hospitals but we are spending tons of

0:06:22.880,0:06:26.639
money on health care

0:06:24.160,0:06:28.080
um and obviously there needs to be some

0:06:26.639,0:06:29.759
sort of change going forward for a

0:06:28.080,0:06:31.120
healthcare system to be able to pay for

0:06:29.759,0:06:32.080
people who are also left out of our

0:06:31.120,0:06:34.479
system

0:06:32.080,0:06:35.840
and so i guess i’ll go over four models

0:06:34.479,0:06:38.080
and if you guys have questions

0:06:35.840,0:06:39.360
i hope i i’m able to answer them uh but

0:06:38.080,0:06:42.160
i can also sort of

0:06:39.360,0:06:43.440
give a little brief history of um where

0:06:42.160,0:06:44.720
these models come from

0:06:43.440,0:06:46.800
and sort of the countries that are

0:06:44.720,0:06:50.400
utilizing these models

0:06:46.800,0:06:53.440
so really these models focus on uh

0:06:50.400,0:06:55.440
two main i guess uh categories so really

0:06:53.440,0:06:58.000
it’s who’s paying for health care

0:06:55.440,0:06:59.680
and who’s providing health care um and

0:06:58.000,0:07:00.960
so in one of the first models that

0:06:59.680,0:07:03.759
that’s spoken

0:07:00.960,0:07:05.599
it’s termed the beverage model and

0:07:03.759,0:07:08.400
william beveridge was

0:07:05.599,0:07:10.000
a british man uh and i believe that the

0:07:08.400,0:07:11.199
history here is that uh winston

0:07:10.000,0:07:13.840
churchill after world war

0:07:11.199,0:07:15.759
ii actually employed uh lord william

0:07:13.840,0:07:17.759
beveridge to investigate sort of social

0:07:15.759,0:07:20.240
services for the united kingdom

0:07:17.759,0:07:21.440
and uh based on his investigation they

0:07:20.240,0:07:23.199
decided that it was the government’s

0:07:21.440,0:07:24.560
responsibility to cover everyone in

0:07:23.199,0:07:26.400
health care so it was decided pretty

0:07:24.560,0:07:28.400
early on for the united kingdom

0:07:26.400,0:07:30.319
um and the beverage model uh to

0:07:28.400,0:07:31.840
summarize it’s it’s universal healthcare

0:07:30.319,0:07:33.280
coverage that’s financed by the

0:07:31.840,0:07:34.560
government so they are the ones who are

0:07:33.280,0:07:37.360
paying for it

0:07:34.560,0:07:39.199
um and the government owns uh everything

0:07:37.360,0:07:41.919
that’s provided for people so they own

0:07:39.199,0:07:43.199
um the physicians and uh all the other

0:07:41.919,0:07:44.879
things that go with providing health

0:07:43.199,0:07:46.080
care for these people

0:07:44.879,0:07:49.919
and it’s financed by the government

0:07:46.080,0:07:49.919
through tax payments

0:07:50.080,0:07:54.240
and other heavy leverages but the

0:07:52.720,0:07:55.440
british people are very happy with the

0:07:54.240,0:07:57.280
system so

0:07:55.440,0:07:59.039
this is actually a model that’s used in

0:07:57.280,0:08:01.360
the uk where it was sort of

0:07:59.039,0:08:03.199
invented and and sort of kinked out and

0:08:01.360,0:08:04.560
then also in other countries like spain

0:08:03.199,0:08:05.280
and new zealand have sort of adopted

0:08:04.560,0:08:07.599
this

0:08:05.280,0:08:08.720
more um socialized medicine which

0:08:07.599,0:08:10.400
actually i think a lot of people

0:08:08.720,0:08:12.000
stereotype that like all of europe had

0:08:10.400,0:08:13.039
socialized medicine right

0:08:12.000,0:08:14.720
but if you’re thinking about that

0:08:13.039,0:08:15.280
stereotypical socialized medicine i

0:08:14.720,0:08:16.879
think this

0:08:15.280,0:08:18.160
is definitely found in the uk and they

0:08:16.879,0:08:18.879
tournament uh the national health

0:08:18.160,0:08:21.840
service is

0:08:18.879,0:08:22.160
who provides all of that uh the second

0:08:21.840,0:08:23.759
oh

0:08:22.160,0:08:26.160
sorry before you go ahead so under the

0:08:23.759,0:08:29.759
beverage model how does that affect

0:08:26.160,0:08:31.039
the wages of um like medical workers

0:08:29.759,0:08:33.039
like healthcare workers because

0:08:31.039,0:08:34.399
one of the main arguments i hear against

0:08:33.039,0:08:36.719
socialized medicine

0:08:34.399,0:08:38.719
as americans like to put it is that it

0:08:36.719,0:08:39.519
would decrease the wages for healthcare

0:08:38.719,0:08:41.919
workers

0:08:39.519,0:08:43.760
so like what does that look like in the

0:08:41.919,0:08:45.760
uk

0:08:43.760,0:08:47.360
yeah great question so like what i know

0:08:45.760,0:08:49.279
from um just some background

0:08:47.360,0:08:51.120
reading and talking to friends in the uk

0:08:49.279,0:08:52.880
so i i lived in the uk for

0:08:51.120,0:08:54.480
a little bit and got to experience the

0:08:52.880,0:08:55.920
nhs

0:08:54.480,0:08:57.600
but but something that they they have

0:08:55.920,0:08:58.720
struggled is yeah celery does come down

0:08:57.600,0:09:00.399
for specialized

0:08:58.720,0:09:02.240
areas of medicine so something like i

0:09:00.399,0:09:03.680
don’t know a neurosurgeon is paid

0:09:02.240,0:09:05.279
much less in the uk than they would be

0:09:03.680,0:09:07.040
paid in the united states health care

0:09:05.279,0:09:08.880
system

0:09:07.040,0:09:11.440
i know that there’s this is an anecdotal

0:09:08.880,0:09:12.800
story but i know that sort of in history

0:09:11.440,0:09:14.800
i mean every country struggles with

0:09:12.800,0:09:16.800
providing family care physicians

0:09:14.800,0:09:18.240
um and the way that the uk has done this

0:09:16.800,0:09:20.000
is that they’ve decided to pay

0:09:18.240,0:09:22.399
family care practice positions in the uk

0:09:20.000,0:09:23.920
more so i believe like their workforce

0:09:22.399,0:09:26.080
is made up of over 60

0:09:23.920,0:09:27.839
family care practice physicians who make

0:09:26.080,0:09:28.320
twice of what a specialty doctor would

0:09:27.839,0:09:30.640
make

0:09:28.320,0:09:32.640
and it sort of has i mean with this

0:09:30.640,0:09:33.680
control by the nhs they’ve sort of been

0:09:32.640,0:09:35.839
able to

0:09:33.680,0:09:37.279
change um what types of physicians

0:09:35.839,0:09:37.920
people want to be in the uk and practice

0:09:37.279,0:09:39.680
as

0:09:37.920,0:09:41.680
but has also sort of covered that

0:09:39.680,0:09:42.480
shortage for them um so i think when you

0:09:41.680,0:09:44.560
have

0:09:42.480,0:09:45.760
a system where the government is running

0:09:44.560,0:09:48.800
both payments and

0:09:45.760,0:09:50.480
sort of providers they have so much more

0:09:48.800,0:09:52.080
control and regulation over

0:09:50.480,0:09:53.760
um how they want to switch the the

0:09:52.080,0:09:55.200
dynamic instead of it being very slow

0:09:53.760,0:09:57.920
and sort of like this free market type

0:09:55.200,0:09:57.920
of exchange

0:09:58.320,0:10:01.839
oh also i have like sorry i have a

0:10:00.720,0:10:04.240
question about

0:10:01.839,0:10:05.279
just like european healthcare in general

0:10:04.240,0:10:07.200
because

0:10:05.279,0:10:09.600
so i know like because of brexit like

0:10:07.200,0:10:14.000
england is like no longer part of the eu

0:10:09.600,0:10:17.519
but um as a part of the eu isn’t there

0:10:14.000,0:10:20.800
like their healthcare

0:10:17.519,0:10:22.399
isn’t it also like if you live in the eu

0:10:20.800,0:10:22.959
and you visit another country that’s in

0:10:22.399,0:10:25.440
the eu

0:10:22.959,0:10:26.880
isn’t your like healthcare covered if

0:10:25.440,0:10:28.800
you need to go to the hospital

0:10:26.880,0:10:30.480
in another eu country like do you know

0:10:28.800,0:10:32.399
how that works

0:10:30.480,0:10:34.079
yeah no that’s a great question i don’t

0:10:32.399,0:10:36.880
actually know the answer to

0:10:34.079,0:10:38.560
to to that but i mean um i guess you can

0:10:36.880,0:10:39.920
share a personal experience of just

0:10:38.560,0:10:42.079
going from like the united states to the

0:10:39.920,0:10:44.160
uk um not within europe

0:10:42.079,0:10:45.760
exactly but i essentially just paid a

0:10:44.160,0:10:47.920
health surcharge fee

0:10:45.760,0:10:49.279
when i sort of i guess immigrated to the

0:10:47.920,0:10:50.720
uk for school

0:10:49.279,0:10:52.480
um and the health search engine fee was

0:10:50.720,0:10:54.720
not that much money it was 1200

0:10:52.480,0:10:55.920
but i was covered in the nhs system so i

0:10:54.720,0:10:58.000
mean if i had

0:10:55.920,0:11:00.320
um come down with something very severe

0:10:58.000,0:11:01.920
like breaking my leg in a bike accident

0:11:00.320,0:11:03.920
i would never receive a bill for that by

0:11:01.920,0:11:05.600
the nhs and it was all covered by just

0:11:03.920,0:11:07.040
that international surcharge

0:11:05.600,0:11:09.120
fee that i paid for health insurance to

0:11:07.040,0:11:11.920
be covered for the year that i was there

0:11:09.120,0:11:13.839
um so i think that’s a also something

0:11:11.920,0:11:15.839
that my friends in the uk sort of

0:11:13.839,0:11:17.279
are always shocked about when i talk to

0:11:15.839,0:11:19.519
them about like co-pays

0:11:17.279,0:11:21.200
uh my friends are like what’s a copay i

0:11:19.519,0:11:23.200
never pay anything for health care so i

0:11:21.200,0:11:25.120
mean it’s it’s covered by the government

0:11:23.200,0:11:27.040
and with that they’ve had to cut a

0:11:25.120,0:11:29.040
little bit

0:11:27.040,0:11:30.560
for costs and things like that so they

0:11:29.040,0:11:32.480
also do decide

0:11:30.560,0:11:34.320
um they do have to make some i guess

0:11:32.480,0:11:35.839
harder decisions later on about who can

0:11:34.320,0:11:37.440
receive what type of care

0:11:35.839,0:11:39.279
or what type of care is necessary for

0:11:37.440,0:11:41.600
someone to receive so

0:11:39.279,0:11:43.120
um another story that i have from a

0:11:41.600,0:11:46.000
friend who’s in britain

0:11:43.120,0:11:46.480
um is her wisdom teeth are growing out

0:11:46.000,0:11:48.160
but

0:11:46.480,0:11:50.800
because they’re not causing her any pain

0:11:48.160,0:11:53.279
nhs doesn’t cover wisdom teeth removal

0:11:50.800,0:11:56.240
um so until they start to cause her pain

0:11:53.279,0:11:58.079
the nhs won’t step in to pay for that

0:11:56.240,0:12:00.399
and so there are like various other

0:11:58.079,0:12:01.279
things that they control and decide to

0:12:00.399,0:12:04.079
pay for

0:12:01.279,0:12:05.600
um trv talks about a really funny one um

0:12:04.079,0:12:07.440
is that the british healthcare system

0:12:05.600,0:12:09.360
covers the viagra pill

0:12:07.440,0:12:10.800
uh and viagra is like a very expensive

0:12:09.360,0:12:12.320
drug in the united states

0:12:10.800,0:12:13.920
and so everyone’s wondering like okay if

0:12:12.320,0:12:14.880
the nhs is pressed for money why are

0:12:13.920,0:12:16.320
they covering such

0:12:14.880,0:12:17.920
uh i mean a drug that seems like a

0:12:16.320,0:12:19.120
luxury or something that you would pay

0:12:17.920,0:12:21.120
out of pocket for

0:12:19.120,0:12:22.639
um and they’re very proud that i think

0:12:21.120,0:12:24.399
um i’ve read this

0:12:22.639,0:12:25.920
uh or i’ve seen it on a video but

0:12:24.399,0:12:27.040
they’re very proud that the inventor of

0:12:25.920,0:12:30.480
viagra was british

0:12:27.040,0:12:33.920
so they’re sort of that additional pride

0:12:30.480,0:12:36.000
yeah that’s literally so funny

0:12:33.920,0:12:37.920
yeah so i mean they have control over

0:12:36.000,0:12:39.360
what they’re willing to pay for and who

0:12:37.920,0:12:41.600
can receive the care

0:12:39.360,0:12:43.200
uh but it’s a little bit always sort of

0:12:41.600,0:12:45.120
a tug and pull balance there

0:12:43.200,0:12:46.560
yeah so uh i guess while we’re talking

0:12:45.120,0:12:47.680
about the uk and sort of the beverage

0:12:46.560,0:12:50.720
model

0:12:47.680,0:12:51.600
um i i can talk about some statistics so

0:12:50.720,0:12:53.760
sort of

0:12:51.600,0:12:54.720
uh health outcomes of what their system

0:12:53.760,0:12:56.639
provides for their people

0:12:54.720,0:12:58.000
compared to the us so we can talk about

0:12:56.639,0:13:00.320
some statistics now

0:12:58.000,0:13:02.079
um and i’ll quickly give an overview of

0:13:00.320,0:13:04.079
sort of health care spending

0:13:02.079,0:13:06.000
so in terms of health care spending per

0:13:04.079,0:13:08.959
person in 2018

0:13:06.000,0:13:11.440
the average um british person spends

0:13:08.959,0:13:13.279
four thousand and seventy dollars versus

0:13:11.440,0:13:14.720
the average person in the united states

0:13:13.279,0:13:16.720
is spending ten thousand five hundred

0:13:14.720,0:13:18.880
and eighty six dollars so we’re spending

0:13:16.720,0:13:20.480
more than double of what um people in

0:13:18.880,0:13:22.959
the uk do per person

0:13:20.480,0:13:24.079
uh with our our different systems uh and

0:13:22.959,0:13:25.680
then if you want to

0:13:24.079,0:13:27.839
use another metric there’s healthcare

0:13:25.680,0:13:29.920
spending by percent of gdp so

0:13:27.839,0:13:32.160
total gdp of the country in 2018 in the

0:13:29.920,0:13:34.320
uk they spend about 9.8

0:13:32.160,0:13:35.920
of their total gdp on health care and in

0:13:34.320,0:13:39.040
the united states that’s much

0:13:35.920,0:13:41.519
much higher at 16.9 percent in 2018

0:13:39.040,0:13:43.040
when that was last calculated um also

0:13:41.519,0:13:45.440
health outcomes for people

0:13:43.040,0:13:46.560
in these systems uh there are huge

0:13:45.440,0:13:48.320
differences

0:13:46.560,0:13:51.199
life expectancy at birth in the uk in

0:13:48.320,0:13:53.839
2017 was on average 81.3

0:13:51.199,0:13:54.959
uh versus the united states around 78.6

0:13:53.839,0:13:56.959
so you have a huge

0:13:54.959,0:13:58.720
uh difference in life expectancy for

0:13:56.959,0:14:00.720
people also the infor

0:13:58.720,0:14:02.079
infant mortality rate per 1000 births

0:14:00.720,0:14:03.839
which is sort of a measure of how well

0:14:02.079,0:14:06.160
the system is doing

0:14:03.839,0:14:08.720
for people there in the uk was 3.9 in

0:14:06.160,0:14:10.000
2017 and in the us it was 5.8 so we have

0:14:08.720,0:14:13.199
a much higher

0:14:10.000,0:14:14.560
mortality rate in the us as well so

0:14:13.199,0:14:16.079
you do see that they’re spending nearly

0:14:14.560,0:14:17.040
half of what we spend in healthcare in

0:14:16.079,0:14:18.880
the united states

0:14:17.040,0:14:20.560
but also having at least comparable or

0:14:18.880,0:14:23.440
even greater health outcomes

0:14:20.560,0:14:23.760
than we are um and just to summarize i

0:14:23.440,0:14:26.079
mean

0:14:23.760,0:14:27.279
it’s a service you use and you never get

0:14:26.079,0:14:28.480
a bill but you are paying it through

0:14:27.279,0:14:30.079
higher income taxes

0:14:28.480,0:14:31.279
but again if people want to argue and

0:14:30.079,0:14:31.920
say like oh i don’t want to be taxed

0:14:31.279,0:14:34.880
more

0:14:31.920,0:14:37.680
um health care spending per person that

0:14:34.880,0:14:40.240
that statistic sort of brings

0:14:37.680,0:14:41.680
back back the reality that people in the

0:14:40.240,0:14:43.360
united states maybe you’re not paying

0:14:41.680,0:14:45.040
more in income taxes but you are paying

0:14:43.360,0:14:46.399
more out of pocket for drugs

0:14:45.040,0:14:48.240
and for procedures that aren’t covered

0:14:46.399,0:14:49.279
by health insurance companies or even

0:14:48.240,0:14:51.680
a different thing that you’re covered by

0:14:49.279,0:14:54.160
like medicare medicaid um and so

0:14:51.680,0:14:55.839
i think that’s uh where the discussion

0:14:54.160,0:14:58.800
starts with that sort of argument

0:14:55.839,0:15:00.480
um and yeah so the way that that people

0:14:58.800,0:15:02.320
pay for it if that’s a question

0:15:00.480,0:15:03.519
uh that you guys have uh so the more

0:15:02.320,0:15:05.199
money you earn of course

0:15:03.519,0:15:06.800
the more taxes you pay and the better

0:15:05.199,0:15:08.959
you contribute to the system

0:15:06.800,0:15:10.399
um and like i mentioned some some

0:15:08.959,0:15:12.720
services are paid out of pocket like

0:15:10.399,0:15:14.480
dental eyes and some prescription drugs

0:15:12.720,0:15:16.320
um but these lo these costs are still

0:15:14.480,0:15:18.000
low compared to the us so

0:15:16.320,0:15:20.160
um i think the statistic was that they

0:15:18.000,0:15:21.519
still pay 57 percent less than the u.s

0:15:20.160,0:15:25.040
and sort of these terms of

0:15:21.519,0:15:25.360
health care um uh in terms of providing

0:15:25.040,0:15:27.120
this

0:15:25.360,0:15:28.639
this sort of health care so for dental

0:15:27.120,0:15:31.440
prescription drugs

0:15:28.639,0:15:32.720
um and then again most of the general

0:15:31.440,0:15:34.880
practitioners or family practice

0:15:32.720,0:15:36.160
physicians are contractors with nhs

0:15:34.880,0:15:38.959
so they kind of contract with the

0:15:36.160,0:15:40.399
government and establish contracts with

0:15:38.959,0:15:41.920
how much they can earn for their

0:15:40.399,0:15:42.800
services so the government sets that

0:15:41.920,0:15:44.399
price list

0:15:42.800,0:15:46.079
of how many patients they see and what

0:15:44.399,0:15:49.759
they pay

0:15:46.079,0:15:52.240
these health care physicians

0:15:49.759,0:15:53.680
and i guess just to end there with the

0:15:52.240,0:15:54.720
uk there’s very strong support for the

0:15:53.680,0:15:56.560
nhs

0:15:54.720,0:15:58.560
and the united kingdom and i think all

0:15:56.560,0:16:00.079
british people are very proud of their

0:15:58.560,0:16:00.639
system because i think they know that it

0:16:00.079,0:16:03.519
works

0:16:00.639,0:16:04.320
better than the us’s uh and there’s and

0:16:03.519,0:16:05.600
i mean

0:16:04.320,0:16:07.199
they really don’t know what it’s like to

0:16:05.600,0:16:08.240
just get a bill for healthcare because

0:16:07.199,0:16:10.639
it’s something that they use

0:16:08.240,0:16:12.639
as a service um provided for everyone

0:16:10.639,0:16:15.600
must be nice also can you define

0:16:12.639,0:16:16.800
nhs for everyone oh sorry yeah i’m so

0:16:15.600,0:16:18.560
sorry that means the national health

0:16:16.800,0:16:20.560
service so that’s uh what what britain

0:16:18.560,0:16:23.040
has termed yeah their health care system

0:16:20.560,0:16:24.399
oh okay so that’s just like britain’s

0:16:23.040,0:16:28.079
healthcare system is what they

0:16:24.399,0:16:31.120
just bring yeah the nhs

0:16:28.079,0:16:33.920
wow i can’t imagine like

0:16:31.120,0:16:35.600
never having a copay and just like you

0:16:33.920,0:16:37.199
just walk out

0:16:35.600,0:16:38.959
yeah i was listening to a podcast the

0:16:37.199,0:16:41.680
other day and it was from

0:16:38.959,0:16:43.680
i think like npr life kit and they were

0:16:41.680,0:16:45.680
saying like this is how you negotiate

0:16:43.680,0:16:47.920
your way out of a medical bill

0:16:45.680,0:16:49.279
i was like the fact that we need to have

0:16:47.920,0:16:50.639
like informational

0:16:49.279,0:16:53.040
and there’s like a whole system of how

0:16:50.639,0:16:55.120
to do it um and all these terrible

0:16:53.040,0:16:56.639
stories of people who have been slammed

0:16:55.120,0:16:57.519
with like a hundred thousand dollars in

0:16:56.639,0:16:59.440
bills for like

0:16:57.519,0:17:01.680
emergency surgery i was like we

0:16:59.440,0:17:03.120
shouldn’t have to have this discussion

0:17:01.680,0:17:06.240
anyways this wouldn’t be something

0:17:03.120,0:17:07.839
as part of the life kit from npr that

0:17:06.240,0:17:09.600
you need to know

0:17:07.839,0:17:11.760
yeah it’s it’s really crazy and i think

0:17:09.600,0:17:13.520
um i mean i’ll get into talking about

0:17:11.760,0:17:15.039
sort of health insurance companies and

0:17:13.520,0:17:16.319
other european european countries around

0:17:15.039,0:17:18.400
the world but like they are different

0:17:16.319,0:17:19.600
from the ones we have in the u.s because

0:17:18.400,0:17:21.280
here in the u.s like you can still have

0:17:19.600,0:17:21.760
a health insurance company deny your

0:17:21.280,0:17:23.600
claim

0:17:21.760,0:17:25.120
so they can say like oh i’m not going to

0:17:23.600,0:17:26.000
cover that like you got treated for it

0:17:25.120,0:17:27.919
but i won’t cover it

0:17:26.000,0:17:29.919
um and elsewhere in other richer

0:17:27.919,0:17:31.440
countries like there’s regulation where

0:17:29.919,0:17:32.720
insurance companies can never deny a

0:17:31.440,0:17:34.559
health claim so they have to pay you

0:17:32.720,0:17:36.320
back even in a certain amount of time

0:17:34.559,0:17:38.080
or your premiums free the next month or

0:17:36.320,0:17:39.679
something like that so

0:17:38.080,0:17:41.440
there’s just so much more regulation i

0:17:39.679,0:17:43.919
think even in health insurance companies

0:17:41.440,0:17:45.200
in other in other richer countries

0:17:43.919,0:17:47.440
around the world

0:17:45.200,0:17:48.960
so i guess that’s a great overview of

0:17:47.440,0:17:51.360
what um

0:17:48.960,0:17:53.360
the i i guess i’m i’m stereotyping here

0:17:51.360,0:17:54.080
too but like most of what americans

0:17:53.360,0:17:56.720
think

0:17:54.080,0:17:57.919
um healthcare is like in in europe but

0:17:56.720,0:18:01.280
the truth of matter is

0:17:57.919,0:18:03.760
um other countries in europe also have

0:18:01.280,0:18:04.799
um different healthcare models and and

0:18:03.760,0:18:06.799
the second one that i’m talking about

0:18:04.799,0:18:08.720
today is called the bismarck model

0:18:06.799,0:18:10.559
uh yeah no so the second model that uh

0:18:08.720,0:18:11.360
tree talks about in his book the healing

0:18:10.559,0:18:13.360
of america

0:18:11.360,0:18:15.120
um and explains a lot of what other

0:18:13.360,0:18:15.840
countries do is called the bismarck

0:18:15.120,0:18:18.160
model

0:18:15.840,0:18:19.280
um so the bismarck model is uh used by

0:18:18.160,0:18:22.640
countries like germany

0:18:19.280,0:18:23.440
france uh japan um and other european

0:18:22.640,0:18:25.679
countries

0:18:23.440,0:18:28.080
and so some history on that the bismarck

0:18:25.679,0:18:29.440
model is actually named after otto van

0:18:28.080,0:18:31.280
bismark

0:18:29.440,0:18:34.480
who was sort of one of the first people

0:18:31.280,0:18:37.760
i think in the 1870s to sort of

0:18:34.480,0:18:39.120
unified sorry unified all of these uh

0:18:37.760,0:18:41.200
german-speaking countries i think

0:18:39.120,0:18:42.080
prussia was one into one country called

0:18:41.200,0:18:46.640
germany

0:18:42.080,0:18:48.000
um and he created many sort of um

0:18:46.640,0:18:49.520
well i guess what i’m trying to say is

0:18:48.000,0:18:50.240
he created the welfare state and started

0:18:49.520,0:18:51.679
to send

0:18:50.240,0:18:53.679
everyone money from the government so

0:18:51.679,0:18:55.440
sort of this more like prominent role of

0:18:53.679,0:18:57.440
the government and the people

0:18:55.440,0:18:58.960
he was one of the first people to think

0:18:57.440,0:19:01.039
about things like social security

0:18:58.960,0:19:03.919
workman’s compensation

0:19:01.039,0:19:04.320
and then by the late 1800s i think is

0:19:03.919,0:19:06.640
when

0:19:04.320,0:19:08.960
a universal healthcare system through

0:19:06.640,0:19:11.120
insurance companies was established by

0:19:08.960,0:19:12.559
ottoman bismarck and so it’s termed sort

0:19:11.120,0:19:14.640
of the bismarck model

0:19:12.559,0:19:15.919
uh first developed then and still used

0:19:14.640,0:19:18.640
in germany today

0:19:15.919,0:19:19.280
um so again going back to organizing how

0:19:18.640,0:19:21.360
these

0:19:19.280,0:19:23.919
models differ it’s really who’s paying

0:19:21.360,0:19:26.240
for it and who’s providing care right

0:19:23.919,0:19:27.039
so in the bismarck model who’s paying

0:19:26.240,0:19:29.440
for it so the

0:19:27.039,0:19:30.799
the system is actually financed by

0:19:29.440,0:19:34.000
insurance companies

0:19:30.799,0:19:35.760
um with employers and employees

0:19:34.000,0:19:37.919
um sort of splitting the cost through

0:19:35.760,0:19:39.760
payroll deductions

0:19:37.919,0:19:41.440
sort of what might sound very familiar

0:19:39.760,0:19:44.000
to what we have in the u.s

0:19:41.440,0:19:44.880
and what many or even a majority of

0:19:44.000,0:19:47.919
americans

0:19:44.880,0:19:50.559
have health and insurance and

0:19:47.919,0:19:53.440
through but in contrast to the us these

0:19:50.559,0:19:55.600
insurance companies are all non-profit

0:19:53.440,0:19:57.039
they are regulated and must enroll all

0:19:55.600,0:20:00.080
citizens regardless of

0:19:57.039,0:20:01.840
pre-existing health conditions and also

0:20:00.080,0:20:04.080
in contrast to the us the government

0:20:01.840,0:20:05.360
will step in when someone is unemployed

0:20:04.080,0:20:07.440
and pay

0:20:05.360,0:20:08.880
for someone to have uh insurance through

0:20:07.440,0:20:10.240
one of these healthcare companies so i

0:20:08.880,0:20:11.679
mean in the u.s if you’re laid off from

0:20:10.240,0:20:12.480
your job you lose your health insurance

0:20:11.679,0:20:15.360
because

0:20:12.480,0:20:16.320
your premium is paid pretty much through

0:20:15.360,0:20:18.720
through them as well as

0:20:16.320,0:20:20.240
your own income but in other countries

0:20:18.720,0:20:22.159
especially germany the government steps

0:20:20.240,0:20:23.679
in when someone becomes unemployed to

0:20:22.159,0:20:25.600
cover their care

0:20:23.679,0:20:26.720
um and then again going back to that

0:20:25.600,0:20:28.559
second part of the question so who’s

0:20:26.720,0:20:30.400
providing the care in the bizmark model

0:20:28.559,0:20:31.919
so all the hospitals and practices are

0:20:30.400,0:20:33.520
actually private practice

0:20:31.919,0:20:35.039
so they’re not run by the government

0:20:33.520,0:20:36.559
like the national health service in the

0:20:35.039,0:20:40.400
uk

0:20:36.559,0:20:42.799
um and really generally germans and

0:20:40.400,0:20:44.640
other people who use this system really

0:20:42.799,0:20:46.400
like their health insurance companies

0:20:44.640,0:20:48.240
uh because insurance companies have to

0:20:46.400,0:20:49.919
pay doctors within a certain amount of

0:20:48.240,0:20:51.679
time so i mean i think it’s even a few

0:20:49.919,0:20:52.880
days in germany um

0:20:51.679,0:20:54.320
where the doctor can build the insurance

0:20:52.880,0:20:54.960
company and they have to pay them within

0:20:54.320,0:20:57.200
a like

0:20:54.960,0:20:58.000
three day period um also on top of that

0:20:57.200,0:20:59.679
if patients pay

0:20:58.000,0:21:00.960
out of pocket for care they have to be

0:20:59.679,0:21:02.880
reimbursed within something like a

0:21:00.960,0:21:04.559
two-week period

0:21:02.880,0:21:06.400
or your premium is free the next month

0:21:04.559,0:21:07.679
so there’s a lot of these sort of

0:21:06.400,0:21:09.760
checks and balances with insurance

0:21:07.679,0:21:11.840
companies and people using

0:21:09.760,0:21:13.360
them in bismarck model countries but

0:21:11.840,0:21:14.559
they also have really strict regulation

0:21:13.360,0:21:16.080
of insurance companies

0:21:14.559,0:21:17.600
um so like i mentioned previously they

0:21:16.080,0:21:21.360
can’t deny health claims

0:21:17.600,0:21:23.280
so they have to cover everything um also

0:21:21.360,0:21:24.960
you may ask like how do unemployed or

0:21:23.280,0:21:28.159
self-employed individuals

0:21:24.960,0:21:29.440
um not lose health insurance or how do

0:21:28.159,0:21:30.240
they deal with that in countries like

0:21:29.440,0:21:31.679
this and

0:21:30.240,0:21:33.520
the government will still step in and

0:21:31.679,0:21:35.679
pay half of your premium or the whole

0:21:33.520,0:21:37.840
premium depending on your income level

0:21:35.679,0:21:38.799
um so even people who are unemployed or

0:21:37.840,0:21:40.480
self-employed

0:21:38.799,0:21:42.559
uh still have some of the help from the

0:21:40.480,0:21:43.840
government but for the most part the

0:21:42.559,0:21:47.120
government sort of has

0:21:43.840,0:21:49.360
a lot of insurance companies to finance

0:21:47.120,0:21:50.400
health care in these countries but it

0:21:49.360,0:21:52.799
works well because they have great

0:21:50.400,0:21:55.679
regulation of insurance companies

0:21:52.799,0:21:57.520
okay question on that is there a cut off

0:21:55.679,0:21:58.080
on your salary range where they will

0:21:57.520,0:22:00.159
stop

0:21:58.080,0:22:01.919
helping you pay so let’s say you’re

0:22:00.159,0:22:05.200
making like six figures

0:22:01.919,0:22:06.640
and then you lost your job like you have

0:22:05.200,0:22:08.159
this whole family and everything does

0:22:06.640,0:22:12.480
the government still come in or do you

0:22:08.159,0:22:14.960
make too much for them to come help you

0:22:12.480,0:22:16.640
yeah good question i think um based off

0:22:14.960,0:22:18.400
of what i know i think that

0:22:16.640,0:22:20.559
premiums are paid on sort of an income

0:22:18.400,0:22:22.080
level uh sort of gradient so if you do

0:22:20.559,0:22:23.360
have a higher income level you’re going

0:22:22.080,0:22:24.640
to be paying the highest premium for

0:22:23.360,0:22:27.200
that insurance company

0:22:24.640,0:22:27.919
whereas if you make not a lot of money

0:22:27.200,0:22:29.760
um

0:22:27.919,0:22:31.679
or you’re sort of low income you get

0:22:29.760,0:22:34.240
more more help from the government and

0:22:31.679,0:22:35.600
that sort of i guess equitable way of

0:22:34.240,0:22:38.480
distributing

0:22:35.600,0:22:39.760
uh what they do for for keeping people

0:22:38.480,0:22:40.960
insured

0:22:39.760,0:22:42.559
but i think what’s really important is

0:22:40.960,0:22:44.480
that the government makes sure that

0:22:42.559,0:22:46.880
everyone in the country is employed

0:22:44.480,0:22:47.919
um because they have either they don’t

0:22:46.880,0:22:49.919
have the money or they have the money to

0:22:47.919,0:22:53.120
pay for health insurance

0:22:49.919,0:22:55.600
wow yeah actually um like i

0:22:53.120,0:22:57.360
so when i was studying abroad in japan i

0:22:55.600,0:23:00.240
was required to

0:22:57.360,0:23:01.200
enroll in health insurance there and as

0:23:00.240,0:23:04.080
a student i

0:23:01.200,0:23:04.559
only paid like ten dollars a month i

0:23:04.080,0:23:07.919
think for

0:23:04.559,0:23:11.200
health insurance and they are for 70

0:23:07.919,0:23:13.280
of my bill so i i never

0:23:11.200,0:23:15.600
actually like ended up going to the

0:23:13.280,0:23:18.720
doctors or like hospital there but

0:23:15.600,0:23:19.280
yeah the monthly cost was so cheap as a

0:23:18.720,0:23:22.320
student

0:23:19.280,0:23:23.600
so it was really nice yeah so i guess i

0:23:22.320,0:23:24.000
mean to keep along the same lines if you

0:23:23.600,0:23:26.799
guys

0:23:24.000,0:23:28.480
want to try to visually compare how

0:23:26.799,0:23:30.559
germany and the uk compared to the us in

0:23:28.480,0:23:31.679
terms of health statistics and spending

0:23:30.559,0:23:33.600
um i can give you some of the same

0:23:31.679,0:23:35.919
statistics and even add a few but health

0:23:33.600,0:23:36.320
spending per person in germany is still

0:23:35.919,0:23:39.440
uh

0:23:36.320,0:23:41.120
kept to 5800 dollars isn’t 17 again

0:23:39.440,0:23:42.640
compared to the us which is over ten

0:23:41.120,0:23:44.559
thousand dollars per person

0:23:42.640,0:23:46.159
um and then percent percent of gdp is

0:23:44.559,0:23:47.039
also a little bit higher than the uk so

0:23:46.159,0:23:49.919
germany spends

0:23:47.039,0:23:51.440
about 11.2 there 11.2 percent of their

0:23:49.919,0:23:54.000
gdp on health care

0:23:51.440,0:23:55.440
um also compared to the us which is over

0:23:54.000,0:23:58.480
16 percent

0:23:55.440,0:24:00.559
um and then again uh i think

0:23:58.480,0:24:02.080
going back to what the benefit of this

0:24:00.559,0:24:04.080
this model is is that the percent of

0:24:02.080,0:24:06.840
people covered by germany is 100

0:24:04.080,0:24:08.640
in the us it’s i think still only around

0:24:06.840,0:24:11.279
91.2

0:24:08.640,0:24:12.559
um that was in 2017 um so even in the

0:24:11.279,0:24:14.320
united states today i’m sure there’s

0:24:12.559,0:24:15.360
more than 28 million people who are

0:24:14.320,0:24:17.440
uninsured

0:24:15.360,0:24:18.400
um or don’t have any health insurance

0:24:17.440,0:24:19.760
but

0:24:18.400,0:24:22.559
this country is able to provide that

0:24:19.760,0:24:22.559
care for everyone

0:24:22.640,0:24:25.679
and then also in comparison i guess

0:24:24.720,0:24:28.400
there are just better

0:24:25.679,0:24:30.000
or comparable health outcomes as well um

0:24:28.400,0:24:32.559
in terms of statistics so

0:24:30.000,0:24:34.240
they do have a longer life expectancy um

0:24:32.559,0:24:37.360
than americans and

0:24:34.240,0:24:38.480
uh a lower um infant mortality rate as

0:24:37.360,0:24:41.440
well

0:24:38.480,0:24:42.960
i’m jealous yeah we pay so much money

0:24:41.440,0:24:46.960
and we’re still gonna die

0:24:42.960,0:24:50.159
first yeah so

0:24:46.960,0:24:50.640
um you asked about south korea uh and

0:24:50.159,0:24:52.080
sort of

0:24:50.640,0:24:53.440
how south korea deals with with health

0:24:52.080,0:24:54.159
insurance and that leads sort of into

0:24:53.440,0:24:56.640
the third type

0:24:54.159,0:24:58.480
the third model that tree discusses and

0:24:56.640,0:25:00.159
going back to those two questions

0:24:58.480,0:25:02.400
um who pays for it and who’s providing

0:25:00.159,0:25:03.760
it so the national

0:25:02.400,0:25:05.440
health insurance model is what it’s

0:25:03.760,0:25:07.679
called it’s used by um

0:25:05.440,0:25:09.279
i mean the main example of the national

0:25:07.679,0:25:11.360
health insurance model is canada

0:25:09.279,0:25:13.039
uh but it’s also by used by smaller

0:25:11.360,0:25:14.480
countries in asia like south korea and

0:25:13.039,0:25:15.840
taiwan

0:25:14.480,0:25:18.720
but it combines a bit of both the

0:25:15.840,0:25:20.880
beverage and bismarck model systems

0:25:18.720,0:25:22.320
where services are provided via private

0:25:20.880,0:25:23.840
health care providers

0:25:22.320,0:25:25.440
but payments are processed through a

0:25:23.840,0:25:27.679
government-run insurance program

0:25:25.440,0:25:29.440
which is funded via taxes or a premium

0:25:27.679,0:25:32.480
paid through employers

0:25:29.440,0:25:34.720
um so you have both like a mix of

0:25:32.480,0:25:36.159
uh who’s paying for it it’s a government

0:25:34.720,0:25:37.760
but who’s providing it it’s actually

0:25:36.159,0:25:39.279
private healthcare providers so it’s

0:25:37.760,0:25:40.880
it’s mixing a little bit of those two

0:25:39.279,0:25:42.720
different model types

0:25:40.880,0:25:44.159
we’ve we’ve talked about the beverage

0:25:42.720,0:25:45.039
model in the uk the bismarck model in

0:25:44.159,0:25:46.400
germany

0:25:45.039,0:25:48.240
uh and then the national health

0:25:46.400,0:25:50.720
insurance model is what we would term

0:25:48.240,0:25:53.200
for canada or south korea and taiwan

0:25:50.720,0:25:53.840
oh the national health insurance model

0:25:53.200,0:25:57.120
okay

0:25:53.840,0:26:01.039
nhi i was like nhs

0:25:57.120,0:26:02.720
no insurance doesn’t start with an s

0:26:01.039,0:26:04.480
but i mean even within these countries

0:26:02.720,0:26:05.039
they’ve termed it their this is sort of

0:26:04.480,0:26:08.080
like

0:26:05.039,0:26:09.520
tr reads umbrella term um and each

0:26:08.080,0:26:11.760
country has its own term for it so like

0:26:09.520,0:26:14.400
in canada they actually term

0:26:11.760,0:26:15.200
their health insurance system as

0:26:14.400,0:26:17.200
medicare

0:26:15.200,0:26:18.720
um talking about the national health

0:26:17.200,0:26:20.880
insurance model in canada

0:26:18.720,0:26:22.080
um they’re able to sort of limit costs

0:26:20.880,0:26:24.000
by limiting treatments

0:26:22.080,0:26:25.440
that are paid for and or making patients

0:26:24.000,0:26:26.799
wait for elective surgeries so you

0:26:25.440,0:26:28.400
always hear about people in the u.s

0:26:26.799,0:26:30.240
maybe complaining that

0:26:28.400,0:26:31.600
people in canada have to wait so long to

0:26:30.240,0:26:34.400
be seen right

0:26:31.600,0:26:35.760
um i mean they they have limited the

0:26:34.400,0:26:37.919
number of surgeons

0:26:35.760,0:26:38.799
um types of medical scans and specialty

0:26:37.919,0:26:41.600
care that they

0:26:38.799,0:26:42.480
that they um are able to use for people

0:26:41.600,0:26:44.240
in canada

0:26:42.480,0:26:46.000
to save money so you will end up on a

0:26:44.240,0:26:47.440
longer waiting list if you need

0:26:46.000,0:26:49.840
to take care of like a shoulder that’s

0:26:47.440,0:26:52.159
just bothering you because of arthritis

0:26:49.840,0:26:53.760
but for acute care everyone is treated

0:26:52.159,0:26:54.880
um but if the medical problem can wait

0:26:53.760,0:26:56.480
then you kind of

0:26:54.880,0:26:58.799
also end up waiting in these in the

0:26:56.480,0:27:01.919
system um and especially in canada

0:26:58.799,0:27:02.320
but again like i mentioned um it’s paid

0:27:01.919,0:27:03.840
for

0:27:02.320,0:27:06.799
through a government-run insurance

0:27:03.840,0:27:09.360
program so sort of like a single-payer

0:27:06.799,0:27:11.360
system so everyone pays a tax uh i think

0:27:09.360,0:27:13.440
they call it a premium in canada

0:27:11.360,0:27:15.520
um where everyone can go to the doctor

0:27:13.440,0:27:16.720
for free uh but they pay into the system

0:27:15.520,0:27:18.480
that pays out to

0:27:16.720,0:27:20.159
all of the privately owned healthcare

0:27:18.480,0:27:21.360
healthcare providers

0:27:20.159,0:27:23.200
so that’s sort of the system and how it

0:27:21.360,0:27:25.039
works in canada

0:27:23.200,0:27:27.120
and how they’ve sort of tried to limit

0:27:25.039,0:27:29.679
costs with it but also make it

0:27:27.120,0:27:30.559
uh work in their own country and then i

0:27:29.679,0:27:33.120
guess

0:27:30.559,0:27:36.080
like jumping to canada and the us since

0:27:33.120,0:27:38.320
we’re sort of comparing statistics here

0:27:36.080,0:27:39.760
they still do have comparable or even

0:27:38.320,0:27:42.799
greater health outcomes than

0:27:39.760,0:27:46.159
what’s being used in the u.s

0:27:42.799,0:27:49.039
they also have cheaper drug prices

0:27:46.159,0:27:50.000
but uh i guess a comparison you can make

0:27:49.039,0:27:52.080
off the bat between

0:27:50.000,0:27:53.679
canada and the us is uh it’s a

0:27:52.080,0:27:55.360
single-payer health care system sort of

0:27:53.679,0:27:56.640
like the proposed medicare for all

0:27:55.360,0:27:58.960
program in the u.s by

0:27:56.640,0:28:00.720
candidates like bernie sanders um that

0:27:58.960,0:28:02.960
you may have heard of and used

0:28:00.720,0:28:03.919
um and i guess in terms of statistics

0:28:02.960,0:28:05.679
health care spending

0:28:03.919,0:28:07.600
five percent of gdp canada spends about

0:28:05.679,0:28:09.919
10 of their gdp

0:28:07.600,0:28:11.279
um in the us is again over 16 to 17

0:28:09.919,0:28:13.440
percent of gdp

0:28:11.279,0:28:15.279
um and in healthcare spending per person

0:28:13.440,0:28:17.279
the system ends up costing people about

0:28:15.279,0:28:19.440
forty five hundred dollars per person

0:28:17.279,0:28:20.399
versus the us which is over ten thousand

0:28:19.440,0:28:23.279
dollars

0:28:20.399,0:28:25.200
um and then even out of pocket spending

0:28:23.279,0:28:25.919
per person is less in canada than it is

0:28:25.200,0:28:27.360
in the us

0:28:25.919,0:28:30.159
uh for other things that aren’t covered

0:28:27.360,0:28:31.520
by uh medicare in canada like certain

0:28:30.159,0:28:31.919
prescription drugs or something like

0:28:31.520,0:28:33.679
that

0:28:31.919,0:28:36.399
they still end up paying less out of

0:28:33.679,0:28:39.039
pocket per person than people in the us

0:28:36.399,0:28:40.240
um and again i guess talking about

0:28:39.039,0:28:41.679
health outcomes

0:28:40.240,0:28:43.679
their basic universal health care

0:28:41.679,0:28:44.159
coverage still has comparable or better

0:28:43.679,0:28:47.200
health

0:28:44.159,0:28:48.880
outcomes compared to us um so

0:28:47.200,0:28:51.200
life expectancy at birth in canada is

0:28:48.880,0:28:53.440
almost 83 uh in the us is

0:28:51.200,0:28:54.320
uh nearing 79 but it’s it’s not quite

0:28:53.440,0:28:56.000
there yet

0:28:54.320,0:28:58.240
um and then even the infor infant

0:28:56.000,0:29:01.760
mortality per 1000 bursts is about 4.8

0:28:58.240,0:29:01.760
in canada in the u.s it’s six

0:29:02.080,0:29:08.080
so i guess just to summarize um

0:29:06.399,0:29:09.840
what what canada is following is sort of

0:29:08.080,0:29:10.960
a publicly funded model with private

0:29:09.840,0:29:13.120
providers

0:29:10.960,0:29:14.960
but it was really i guess canadians take

0:29:13.120,0:29:16.399
a lot of pride in this system because

0:29:14.960,0:29:18.080
it was established to ensure health

0:29:16.399,0:29:19.760
equity among citizens regardless of

0:29:18.080,0:29:21.600
people’s ability regardless of people’s

0:29:19.760,0:29:22.640
ability to pay and keep

0:29:21.600,0:29:24.320
and they do this by keeping

0:29:22.640,0:29:25.520
administrative costs low and sort of

0:29:24.320,0:29:26.399
making those checks and balances in the

0:29:25.520,0:29:29.440
system

0:29:26.399,0:29:31.440
um but i guess you might be asking like

0:29:29.440,0:29:33.440
how do these countries determine what’s

0:29:31.440,0:29:36.240
covered what pills will be paid for

0:29:33.440,0:29:37.919
what procedures are allowed um and in

0:29:36.240,0:29:39.279
canada i mean it’s all determined by the

0:29:37.919,0:29:42.240
health ministry

0:29:39.279,0:29:43.120
um who makes these larger decisions and

0:29:42.240,0:29:44.399
i don’t know where they’re based in

0:29:43.120,0:29:46.720
canada maybe it’s auto

0:29:44.399,0:29:47.760
uh you know actually otto was the

0:29:46.720,0:29:49.600
capital isn’t it

0:29:47.760,0:29:51.120
yeah i think it might be in ottawa where

0:29:49.600,0:29:52.399
the ministry actually meets and decides

0:29:51.120,0:29:53.919
what’s covered every year

0:29:52.399,0:29:55.440
what new pills that have come onto the

0:29:53.919,0:29:58.399
market are paid for

0:29:55.440,0:30:00.240
and which procedures are allowed for um

0:29:58.399,0:30:02.000
basic universal health care coverage

0:30:00.240,0:30:03.360
and then i guess in comparison to the us

0:30:02.000,0:30:05.760
these decisions are made really by

0:30:03.360,0:30:08.960
individual insurance companies so i mean

0:30:05.760,0:30:11.600
say uh nat and jaclyn have different

0:30:08.960,0:30:12.159
uh insurance companies in the us they

0:30:11.600,0:30:14.960
each

0:30:12.159,0:30:16.159
can decide like what sort of healthcare

0:30:14.960,0:30:17.919
procedures are covered

0:30:16.159,0:30:19.360
um so one of you guys may have one

0:30:17.919,0:30:19.919
that’s covered by your own company but

0:30:19.360,0:30:21.279
the other

0:30:19.919,0:30:22.960
won’t and so there’s no really like

0:30:21.279,0:30:24.720
centralized system regulating

0:30:22.960,0:30:26.480
what insurance companies are deciding to

0:30:24.720,0:30:29.039
cover in the us

0:30:26.480,0:30:30.159
but i think like what characterizes

0:30:29.039,0:30:32.640
canada’s system

0:30:30.159,0:30:35.840
uh is really that they’re valuing equity

0:30:32.640,0:30:37.919
so that everyone receives the same care

0:30:35.840,0:30:39.279
although medicare in canada isn’t able

0:30:37.919,0:30:42.799
to cover everything

0:30:39.279,0:30:46.159
like dental and other uh

0:30:42.799,0:30:48.080
healthcare uh costs i think

0:30:46.159,0:30:49.360
one of the other things that uh hasn’t

0:30:48.080,0:30:50.480
been incorporated into the system is

0:30:49.360,0:30:52.640
like

0:30:50.480,0:30:54.240
paying for things like mental health so

0:30:52.640,0:30:55.760
i think therapy

0:30:54.240,0:30:58.480
and things like that isn’t covered by

0:30:55.760,0:31:00.000
the medicare system um but you can

0:30:58.480,0:31:02.000
buy supplemental private insurance

0:31:00.000,0:31:04.399
through employers which do cover things

0:31:02.000,0:31:06.320
like dental insurance

0:31:04.399,0:31:07.679
eyesight and other things like mental

0:31:06.320,0:31:10.640
health services

0:31:07.679,0:31:11.919
um so i guess those are some of the

0:31:10.640,0:31:14.399
problems that a lot of people might talk

0:31:11.919,0:31:17.600
about with canada

0:31:14.399,0:31:21.360
yeah actually like um i

0:31:17.600,0:31:24.559
when i was in ottawa there was like um

0:31:21.360,0:31:28.080
i was interning at uh the parliament

0:31:24.559,0:31:30.240
house of commons and like the mp i was

0:31:28.080,0:31:31.760
interning for he was on the health

0:31:30.240,0:31:35.039
committee and so that was like

0:31:31.760,0:31:37.039
we focused so much about uh providing

0:31:35.039,0:31:39.600
like universal dental care for

0:31:37.039,0:31:40.399
canadians that was like his really that

0:31:39.600,0:31:42.960
was his big

0:31:40.399,0:31:44.640
issue that he was focusing on and so

0:31:42.960,0:31:48.240
yeah i think they’ve been

0:31:44.640,0:31:51.519
really pushing for universal dental care

0:31:48.240,0:31:53.679
in canada because yeah then uh the

0:31:51.519,0:31:54.960
supplemental like private insurance i

0:31:53.679,0:31:58.399
think is really

0:31:54.960,0:32:00.960
expensive um so yeah that’s just like

0:31:58.399,0:32:02.399
something you might see on the news yeah

0:32:00.960,0:32:04.880
no definitely

0:32:02.399,0:32:07.039
oh yeah like i because like you

0:32:04.880,0:32:10.640
mentioned earlier like the really long

0:32:07.039,0:32:12.640
wait times um i’ve also

0:32:10.640,0:32:14.559
yeah that is a complaint that i’ve heard

0:32:12.640,0:32:15.600
like from my canadian friends and then

0:32:14.559,0:32:18.640
also

0:32:15.600,0:32:22.399
i think like sometimes the i guess the

0:32:18.640,0:32:23.760
quality of uh yeah like the quality of

0:32:22.399,0:32:26.559
health services

0:32:23.760,0:32:28.640
can sometimes vary like depending on the

0:32:26.559,0:32:31.360
region of canada you’re living in or

0:32:28.640,0:32:33.120
um i guess like yeah the province um and

0:32:31.360,0:32:34.320
so i guess some canadians like if they

0:32:33.120,0:32:37.760
have a severe

0:32:34.320,0:32:40.320
medical condition that requires like a

0:32:37.760,0:32:43.200
uh what would you call it like a

0:32:40.320,0:32:45.279
specialized physician um

0:32:43.200,0:32:47.519
a lot of canadians like will go to the

0:32:45.279,0:32:48.480
us actually to get like specialized care

0:32:47.519,0:32:51.840
just because

0:32:48.480,0:32:54.159
the quality is i guess a little

0:32:51.840,0:32:54.960
a little better in their opinion but

0:32:54.159,0:32:58.000
yeah

0:32:54.960,0:32:59.200
yeah yeah no i definitely have heard

0:32:58.000,0:33:00.880
about canadians coming

0:32:59.200,0:33:02.799
across the border to get health care um

0:33:00.880,0:33:05.039
for some of those sort of i guess

0:33:02.799,0:33:06.399
uh different like elective or more

0:33:05.039,0:33:08.000
advanced procedures

0:33:06.399,0:33:09.519
um and i guess like something that also

0:33:08.000,0:33:11.679
limits them in canada is that

0:33:09.519,0:33:13.279
because canada has sort of decided on

0:33:11.679,0:33:15.279
health equity as sort of like

0:33:13.279,0:33:16.480
their big decision defining this model

0:33:15.279,0:33:18.559
um

0:33:16.480,0:33:20.880
you can’t even through like supplemental

0:33:18.559,0:33:22.880
private insurance in canada you can’t

0:33:20.880,0:33:24.799
have them pay for a procedure that’s

0:33:22.880,0:33:25.600
covered by medicare in canada so they

0:33:24.799,0:33:27.440
don’t want like

0:33:25.600,0:33:29.360
someone who has a ton of money being

0:33:27.440,0:33:31.200
able to purchase private supplemental

0:33:29.360,0:33:32.960
insurance and then being able to go to

0:33:31.200,0:33:35.039
a better physician when that procedure

0:33:32.960,0:33:36.240
is covered under medicare

0:33:35.039,0:33:38.320
because they want everyone to have the

0:33:36.240,0:33:39.200
same care that’s paid for by the

0:33:38.320,0:33:40.399
government system

0:33:39.200,0:33:42.559
so if you have supplemental private

0:33:40.399,0:33:43.760
insurance in canada it can only pay for

0:33:42.559,0:33:45.519
procedures that aren’t covered by

0:33:43.760,0:33:49.120
medicare

0:33:45.519,0:33:50.840
oh that’s interesting also

0:33:49.120,0:33:53.279
with the canadians that come to the

0:33:50.840,0:33:53.600
states isn’t that really expensive for

0:33:53.279,0:33:55.600
them

0:33:53.600,0:33:56.799
because they wouldn’t have american

0:33:55.600,0:33:59.840
health insurance

0:33:56.799,0:34:00.240
right like it doesn’t transfer over yeah

0:33:59.840,0:34:02.240
i mean

0:34:00.240,0:34:03.440
i’m just assuming that uh they’re maybe

0:34:02.240,0:34:04.799
paying out of pocket for

0:34:03.440,0:34:07.120
some of the procedures that they that

0:34:04.799,0:34:07.679
they get but what like what what type of

0:34:07.120,0:34:09.520
person

0:34:07.679,0:34:10.800
do we have examples because i’m just

0:34:09.520,0:34:12.560
thinking of like

0:34:10.800,0:34:14.159
if you wanted to come over maybe it’s

0:34:12.560,0:34:15.760
something extreme like open heart

0:34:14.159,0:34:18.000
surgery that’s

0:34:15.760,0:34:19.040
could be upwards of like a hundred grand

0:34:18.000,0:34:21.119
do you really wanna

0:34:19.040,0:34:23.280
come to the states and pay a hundred

0:34:21.119,0:34:27.679
grand i guess if it’s life or death yes

0:34:23.280,0:34:29.599
but like you’re uninsured that’s all out

0:34:27.679,0:34:31.280
of pocket

0:34:29.599,0:34:32.879
yeah i mean i think something that comes

0:34:31.280,0:34:34.960
to mind and something i’ve heard of

0:34:32.879,0:34:36.800
is um i don’t know maybe like you you

0:34:34.960,0:34:40.240
have a lousy shoulder

0:34:36.800,0:34:41.520
um and it kind of hurts when you’re like

0:34:40.240,0:34:42.720
trying to grab a cup from the top

0:34:41.520,0:34:44.560
cupboard but

0:34:42.720,0:34:45.599
uh in canada’s system it might take you

0:34:44.560,0:34:46.320
eight to twelve months to get an

0:34:45.599,0:34:48.320
appointment

0:34:46.320,0:34:50.159
to be seen by a specialty care person

0:34:48.320,0:34:51.760
for that sort of like ailment

0:34:50.159,0:34:53.280
um and then it might take another four

0:34:51.760,0:34:55.040
to five months to actually have a

0:34:53.280,0:34:57.119
procedure done where you can

0:34:55.040,0:34:58.880
get that shoulder worked on or fixed so

0:34:57.119,0:35:00.800
like i think something like

0:34:58.880,0:35:02.079
chronic pain and issues that sort of get

0:35:00.800,0:35:03.760
like pushed to the end

0:35:02.079,0:35:05.040
um and something that maybe a canadian

0:35:03.760,0:35:06.480
might come across the border to seek

0:35:05.040,0:35:08.640
care for if they have the money

0:35:06.480,0:35:11.599
okay that makes more sense instead of

0:35:08.640,0:35:13.280
like open heart surgery

0:35:11.599,0:35:16.720
yeah i would hope that’s uh covered by

0:35:13.280,0:35:19.119
medicare and care here right

0:35:16.720,0:35:20.320
yeah i mean but i mean sort of like it’s

0:35:19.119,0:35:22.800
characterized

0:35:20.320,0:35:24.560
i mean okay i’ll start here yeah i mean

0:35:22.800,0:35:25.200
the model might need some reform in the

0:35:24.560,0:35:27.359
future

0:35:25.200,0:35:28.880
um but canadians are still very proud of

0:35:27.359,0:35:30.560
their healthcare system and i think

0:35:28.880,0:35:32.000
a lot of canadians i’ve spoken to and

0:35:30.560,0:35:33.680
maybe not also

0:35:32.000,0:35:35.040
is that they’re very proud because they

0:35:33.680,0:35:36.720
know that it provides sort of

0:35:35.040,0:35:38.079
health care for everyone on an equal

0:35:36.720,0:35:39.200
level but they

0:35:38.079,0:35:40.880
also know that it’s still better than

0:35:39.200,0:35:42.640
the us system there’s lower costs and

0:35:40.880,0:35:45.200
higher health outcomes so

0:35:42.640,0:35:47.440
uh canadians are very proud of that is

0:35:45.200,0:35:48.800
it just is the pride stemming from that

0:35:47.440,0:35:52.400
they’re better than us

0:35:48.800,0:35:56.800
like yeah i mean i think so

0:35:52.400,0:35:56.800
yeah war of 1812 throwback

0:35:57.119,0:35:59.839
right yeah

0:36:00.240,0:36:06.720
i guess enough about canada uh

0:36:03.280,0:36:08.480
and yeah enough about them we don’t need

0:36:06.720,0:36:09.839
that

0:36:08.480,0:36:11.760
and the national health insurance model

0:36:09.839,0:36:12.560
but the last sort of model that tree

0:36:11.760,0:36:14.400
discusses

0:36:12.560,0:36:16.640
is the out-of-pocket model so i mean

0:36:14.400,0:36:18.960
it’s it’s very transparent and

0:36:16.640,0:36:19.680
mostly available in developing countries

0:36:18.960,0:36:22.160
um

0:36:19.680,0:36:23.920
and i think i mean there’s only about 50

0:36:22.160,0:36:24.560
richer countries across the world that

0:36:23.920,0:36:26.880
have

0:36:24.560,0:36:28.240
actually established healthcare systems

0:36:26.880,0:36:30.000
but really most of the countries in the

0:36:28.240,0:36:31.760
world have an out-of-pocket model so i

0:36:30.000,0:36:33.280
mean it’s as simple as it sounds

0:36:31.760,0:36:35.520
only those who have money for healthcare

0:36:33.280,0:36:36.960
can afford to access and pay for it

0:36:35.520,0:36:39.119
um so who’s paying for it it’s out of

0:36:36.960,0:36:42.000
pocket and who’s providing it

0:36:39.119,0:36:43.440
really a combination of private private

0:36:42.000,0:36:44.720
care providers

0:36:43.440,0:36:47.839
so this is something you might see in

0:36:44.720,0:36:50.240
like a rural african country

0:36:47.839,0:36:52.000
and i guess really not great health

0:36:50.240,0:36:54.640
equity there

0:36:52.000,0:36:55.119
i have a question um do you know the

0:36:54.640,0:36:58.960
model

0:36:55.119,0:37:02.320
for specifically like senegal and china

0:36:58.960,0:37:04.079
because i got health care in senegal and

0:37:02.320,0:37:06.400
china and i thought

0:37:04.079,0:37:07.760
first off china was a trip that was like

0:37:06.400,0:37:10.800
the emergency room

0:37:07.760,0:37:13.440
um but it was like affordable

0:37:10.800,0:37:14.880
and i did get the care i needed it just

0:37:13.440,0:37:18.560
was inefficient

0:37:14.880,0:37:20.400
and not as clean as the

0:37:18.560,0:37:23.200
united states but senegal was really

0:37:20.400,0:37:24.720
good um

0:37:23.200,0:37:26.480
yeah so i don’t know and it was like

0:37:24.720,0:37:28.880
very affordable

0:37:26.480,0:37:30.480
like is what model do they have is that

0:37:28.880,0:37:32.400
out of pocket maybe

0:37:30.480,0:37:34.800
yeah i think i think like up the top my

0:37:32.400,0:37:37.680
head um i don’t think china has

0:37:34.800,0:37:39.359
um a system a healthcare system uh that

0:37:37.680,0:37:40.800
is able to or like has even decided to

0:37:39.359,0:37:42.320
try to cover everyone in the country so

0:37:40.800,0:37:43.599
it’s more of an out-of-pocket model so i

0:37:42.320,0:37:45.760
mean if you can provide

0:37:43.599,0:37:47.200
so maybe the healthcare costs are lower

0:37:45.760,0:37:48.480
um but you need the money to pay for

0:37:47.200,0:37:49.839
them because there’s no sort of

0:37:48.480,0:37:52.160
government

0:37:49.839,0:37:53.440
association or even insurance companies

0:37:52.160,0:37:55.200
that are super established with

0:37:53.440,0:37:57.680
providing care for everyone

0:37:55.200,0:37:58.960
um and then senegal i would uh think the

0:37:57.680,0:37:59.680
same but i don’t know off the top of my

0:37:58.960,0:38:03.520
head

0:37:59.680,0:38:06.320
okay yeah i can’t imagine like

0:38:03.520,0:38:08.240
especially china there’s so many people

0:38:06.320,0:38:08.960
there’s like 1.3 billion people so i

0:38:08.240,0:38:11.599
can’t imagine

0:38:08.960,0:38:12.079
like them being able to use like any

0:38:11.599,0:38:14.960
other

0:38:12.079,0:38:16.240
model to like cover every citizen that

0:38:14.960,0:38:18.400
would be yeah right yeah

0:38:16.240,0:38:20.160
yeah definitely i think people talk a

0:38:18.400,0:38:22.960
lot about um

0:38:20.160,0:38:24.640
like the large like brazil india china

0:38:22.960,0:38:26.160
and russia who are all going to surpass

0:38:24.640,0:38:28.079
this a lot in population and how they’re

0:38:26.160,0:38:30.640
going to deal with health care systems

0:38:28.079,0:38:31.680
um but a lot of it right now is sort of

0:38:30.640,0:38:32.480
up in the air and sort of out of the

0:38:31.680,0:38:33.920
pocket

0:38:32.480,0:38:36.560
sort of the out-of-pocket model for most

0:38:33.920,0:38:39.359
people is that kind of why

0:38:36.560,0:38:41.280
i guess the united states healthcare

0:38:39.359,0:38:43.839
compared to other developed countries

0:38:41.280,0:38:46.560
is lacking could it be due to our

0:38:43.839,0:38:48.800
population size yeah so

0:38:46.560,0:38:50.079
you’re i mean that’s like the ultimate

0:38:48.800,0:38:51.040
question right like why is america’s

0:38:50.079,0:38:52.560
health care costs

0:38:51.040,0:38:54.079
so expensive even though we’re the

0:38:52.560,0:38:57.599
richest country in the world

0:38:54.079,0:38:59.680
and um i mean like why is america

0:38:57.599,0:39:01.040
have why does america have worse health

0:38:59.680,0:39:02.160
outcomes in other countries that we’ve

0:39:01.040,0:39:03.920
talked about today

0:39:02.160,0:39:05.200
um and i think the answer to that is

0:39:03.920,0:39:06.800
that we employ

0:39:05.200,0:39:08.560
all of these types of models in various

0:39:06.800,0:39:10.240
ways or different class um

0:39:08.560,0:39:11.920
i’m sorry i’ll go back so like the

0:39:10.240,0:39:13.440
reason really is that america employs

0:39:11.920,0:39:14.240
all these types of models in various

0:39:13.440,0:39:17.119
ways

0:39:14.240,0:39:17.520
um so i think it’s just a regulation of

0:39:17.119,0:39:19.359
i mean

0:39:17.520,0:39:21.040
or really like an organization of using

0:39:19.359,0:39:23.119
so many different models in the u.s

0:39:21.040,0:39:24.960
that it ends up being very expensive in

0:39:23.119,0:39:27.280
administrative costs

0:39:24.960,0:39:28.960
but also there are people who are left

0:39:27.280,0:39:30.240
or falling into different gaps and

0:39:28.960,0:39:31.760
trying to organize so many different

0:39:30.240,0:39:34.720
models for one country

0:39:31.760,0:39:36.160
um so it’s not a one size fit all in the

0:39:34.720,0:39:37.200
us and i think that’s why it’s so

0:39:36.160,0:39:40.480
expensive

0:39:37.200,0:39:42.079
um so depending really where you fall in

0:39:40.480,0:39:44.640
american society

0:39:42.079,0:39:45.920
and trying to get access to healthcare

0:39:44.640,0:39:47.200
providers you receive different

0:39:45.920,0:39:48.640
treatment and care

0:39:47.200,0:39:50.160
and i really think it’s this

0:39:48.640,0:39:51.680
disorganization of our national

0:39:50.160,0:39:53.440
healthcare system that leads to

0:39:51.680,0:39:54.640
high spending per capita and also

0:39:53.440,0:39:55.839
eventually worse health outcomes

0:39:54.640,0:39:56.640
compared to other developed countries

0:39:55.839,0:39:57.920
because you have

0:39:56.640,0:40:00.320
millions of people being left behind

0:39:57.920,0:40:01.520
without health insurance that um

0:40:00.320,0:40:03.760
really speak to a lot in those

0:40:01.520,0:40:05.359
statistics um

0:40:03.760,0:40:06.880
and i mean even for example like we

0:40:05.359,0:40:09.040
don’t go to the doctor as much as

0:40:06.880,0:40:10.319
uh people do in other in other richer

0:40:09.040,0:40:12.480
countries

0:40:10.319,0:40:13.440
for preventative health care treatments

0:40:12.480,0:40:15.839
um and

0:40:13.440,0:40:16.480
even with each visit that we do we pay

0:40:15.839,0:40:20.000
more

0:40:16.480,0:40:21.280
um so i guess it might be helpful to

0:40:20.000,0:40:22.800
expand a bit about how the u.s

0:40:21.280,0:40:23.760
healthcare system employs all of these

0:40:22.800,0:40:25.280
models

0:40:23.760,0:40:26.800
so we can take a look at some of the

0:40:25.280,0:40:28.400
types of people treated in each sector

0:40:26.800,0:40:29.920
and i mean maybe even some listeners

0:40:28.400,0:40:31.760
might be able to identify where they

0:40:29.920,0:40:34.400
they fit in here

0:40:31.760,0:40:36.240
so the first model we talked about the

0:40:34.400,0:40:38.800
beverage model of healthcare

0:40:36.240,0:40:40.480
so native americans in the u.s veterans

0:40:38.800,0:40:41.200
and active duty military personnel are

0:40:40.480,0:40:43.040
covered by

0:40:41.200,0:40:44.160
the beverage model of health care

0:40:43.040,0:40:45.599
similar to what you would find by the

0:40:44.160,0:40:46.880
national health service in britain so

0:40:45.599,0:40:47.599
you never receive a bill for your

0:40:46.880,0:40:49.119
treatment

0:40:47.599,0:40:51.280
you’re treated by the government by

0:40:49.119,0:40:54.160
government hospitals and employees

0:40:51.280,0:40:54.720
and the government buys the pills uh and

0:40:54.160,0:40:56.960
they

0:40:54.720,0:40:58.160
really cover sort of the cost and the

0:40:56.960,0:41:01.200
providing the the care

0:40:58.160,0:41:02.560
so um that’s sort of maybe the type of

0:41:01.200,0:41:03.839
people that you might find

0:41:02.560,0:41:06.079
utilizing the beverage model of

0:41:03.839,0:41:07.760
healthcare in the us whereas the

0:41:06.079,0:41:09.440
bismarck model which is what we talked

0:41:07.760,0:41:10.960
about second in germany

0:41:09.440,0:41:13.119
provided by health insurance companies

0:41:10.960,0:41:15.040
so this is really mostly the majority of

0:41:13.119,0:41:16.400
americans so sort of the working person

0:41:15.040,0:41:18.640
splitting your insurance premium with

0:41:16.400,0:41:20.079
your employer if that sounds familiar

0:41:18.640,0:41:22.160
or if you’re self-employed and buying

0:41:20.079,0:41:24.079
into a health insurance program

0:41:22.160,0:41:26.000
um these are sort of more similar to the

0:41:24.079,0:41:28.960
bismarck model of health care similar to

0:41:26.000,0:41:31.040
france and germany um i think about 150

0:41:28.960,0:41:32.640
to 160 million americans received care

0:41:31.040,0:41:34.400
through this route

0:41:32.640,0:41:35.760
but again the big difference here is

0:41:34.400,0:41:36.880
that our insurance companies aren’t

0:41:35.760,0:41:38.560
heavily regulated

0:41:36.880,0:41:40.400
we even have for-profit insurance

0:41:38.560,0:41:42.560
companies in the u.s still which

0:41:40.400,0:41:44.560
sort of blows my mind i mean uh are you

0:41:42.560,0:41:46.000
putting the money back into

0:41:44.560,0:41:47.760
providing the best care for people or

0:41:46.000,0:41:49.280
are you providing dividends for people

0:41:47.760,0:41:50.880
on a monthly basis so i mean

0:41:49.280,0:41:52.400
the regulation in america really lacks

0:41:50.880,0:41:53.440
in terms of health insurance companies

0:41:52.400,0:41:55.440
compared to

0:41:53.440,0:41:56.880
countries like france and germany um and

0:41:55.440,0:41:58.560
then talking about i mean if you’re over

0:41:56.880,0:41:58.960
65 and you’re getting insurance in the

0:41:58.560,0:42:01.119
us

0:41:58.960,0:42:02.480
through a government-run program called

0:42:01.119,0:42:04.560
medicare

0:42:02.480,0:42:06.079
you’re a person experiencing something

0:42:04.560,0:42:07.839
similar to canada like the national

0:42:06.079,0:42:09.760
health insurance model

0:42:07.839,0:42:10.960
and i think more than 40 million

0:42:09.760,0:42:12.560
americans are on this model in our

0:42:10.960,0:42:16.000
system sort of the aging

0:42:12.560,0:42:16.720
population and then uh if you’re part of

0:42:16.000,0:42:18.640
the

0:42:16.720,0:42:20.240
nearly 30 million uninsured americans in

0:42:18.640,0:42:21.839
the us right now you’re like a person

0:42:20.240,0:42:23.359
living in a developing country in rural

0:42:21.839,0:42:24.800
africa or south america

0:42:23.359,0:42:27.760
because you’re using sort of the out of

0:42:24.800,0:42:30.800
pocket model that we discussed earlier

0:42:27.760,0:42:32.319
um so i guess what tree talks about a

0:42:30.800,0:42:34.480
lot in his book and i’m like

0:42:32.319,0:42:35.520
a huge plug for this book jacqueline

0:42:34.480,0:42:37.760
said it was boring

0:42:35.520,0:42:39.920
yeah you don’t have to bring that in

0:42:37.760,0:42:39.920
there

0:42:40.960,0:42:44.560
i’ll say yeah so i mean another big plug

0:42:43.119,0:42:46.000
for this book the healing of america by

0:42:44.560,0:42:48.880
t.o reid is that

0:42:46.000,0:42:50.400
he is able to i mean bring up like

0:42:48.880,0:42:52.400
what’s the main difference between us

0:42:50.400,0:42:54.720
and other countries around the globe

0:42:52.400,0:42:56.160
um and he mentions that all other

0:42:54.720,0:42:58.319
countries have decided to pursue one

0:42:56.160,0:43:00.240
fundamental model so it’s not a mix of

0:42:58.319,0:43:00.720
all these systems and rules and models

0:43:00.240,0:43:02.079
and

0:43:00.720,0:43:04.079
administrative costs like trying to

0:43:02.079,0:43:06.480
figure out um

0:43:04.079,0:43:08.880
what sort of who’s providing your care

0:43:06.480,0:43:10.880
and who’s going to pay for it

0:43:08.880,0:43:12.640
so i think like that’s the advantage of

0:43:10.880,0:43:14.880
using a one-size-fits-all

0:43:12.640,0:43:16.720
healthcare system especially in the u.s

0:43:14.880,0:43:18.319
um because it becomes

0:43:16.720,0:43:20.160
simpler and cheaper to manage there’s a

0:43:18.319,0:43:22.319
set of rules and prices that are set by

0:43:20.160,0:43:23.760
a governing body there’s cost and

0:43:22.319,0:43:25.359
transparency

0:43:23.760,0:43:27.520
um so if you you go to the doctor and

0:43:25.359,0:43:29.119
you you want a medical procedure

0:43:27.520,0:43:30.800
uh done they can tell you how much it’s

0:43:29.119,0:43:34.079
gonna cost because right now i mean

0:43:30.800,0:43:35.520
if i went to the emergency room um and

0:43:34.079,0:43:36.800
i don’t know needed stitches and asked

0:43:35.520,0:43:38.400
how much it would cost they would say

0:43:36.800,0:43:39.520
well i don’t know like who do you who’s

0:43:38.400,0:43:40.800
your health insurance provider i don’t

0:43:39.520,0:43:42.560
know how much they’re going to cover

0:43:40.800,0:43:44.240
um they won’t be able to tell you versus

0:43:42.560,0:43:45.760
like having a system where you have that

0:43:44.240,0:43:46.880
that price schedule

0:43:45.760,0:43:48.319
and they can tell you exactly how much

0:43:46.880,0:43:50.000
it’s going to cost who they’re going to

0:43:48.319,0:43:52.160
charge who’s going to pay for it

0:43:50.000,0:43:54.640
um and then also i i’ve mentioned

0:43:52.160,0:43:57.359
administrative costs so that’s sort of a

0:43:54.640,0:43:57.680
vague term um but i guess to expand on

0:43:57.359,0:43:59.200
that

0:43:57.680,0:44:01.200
it’s a lot of like the paperwork in the

0:43:59.200,0:44:02.000
back side of deciding who has health

0:44:01.200,0:44:03.440
insurance

0:44:02.000,0:44:05.440
who’s charging their health insurance

0:44:03.440,0:44:07.440
company um and in the us i mean the

0:44:05.440,0:44:09.839
statistic is that

0:44:07.440,0:44:11.520
there’s about an 18 to 25 percent cost

0:44:09.839,0:44:13.040
and just administrative costs to every

0:44:11.520,0:44:14.400
bill that they pay for medical

0:44:13.040,0:44:15.839
procedures

0:44:14.400,0:44:17.839
and what other countries have found

0:44:15.839,0:44:19.520
using one single model is they are able

0:44:17.839,0:44:20.400
to keep these administrative costs low

0:44:19.520,0:44:22.079
so i mean

0:44:20.400,0:44:23.920
canada has a five percent administrative

0:44:22.079,0:44:26.560
costs britain is five percent

0:44:23.920,0:44:28.480
um france is three percent and i think

0:44:26.560,0:44:30.160
taiwan keeps it below two percent of

0:44:28.480,0:44:31.760
administrative costs versus

0:44:30.160,0:44:33.599
the us who is spending a lot more money

0:44:31.760,0:44:35.040
in these terms of in terms of just

0:44:33.599,0:44:36.079
trying to organize and balance all these

0:44:35.040,0:44:39.359
different

0:44:36.079,0:44:41.520
systems yeah it seems like like how i

0:44:39.359,0:44:43.359
can’t even imagine trying to

0:44:41.520,0:44:44.640
regulate everything in our healthcare

0:44:43.359,0:44:46.079
system because there’s

0:44:44.640,0:44:48.079
like there’s so many different models

0:44:46.079,0:44:51.680
and it’s like i guess

0:44:48.079,0:44:54.400
uh it just your healthcare and your

0:44:51.680,0:44:56.240
like health insurance experience depends

0:44:54.400,0:44:58.319
on where you are in society and like

0:44:56.240,0:45:00.000
it’s so different for each person

0:44:58.319,0:45:01.440
it’s like how can you expect to regulate

0:45:00.000,0:45:04.480
that if there’s like

0:45:01.440,0:45:08.800
four different models i guess um

0:45:04.480,0:45:10.240
definitely i think just like one of the

0:45:08.800,0:45:11.920
i mean what’s what’s crazy about our

0:45:10.240,0:45:12.960
healthcare system right now is i mean if

0:45:11.920,0:45:13.680
you’re covered under something like

0:45:12.960,0:45:15.280
medicare

0:45:13.680,0:45:19.119
i mean you’re receiving the same exact

0:45:15.280,0:45:22.319
procedure um

0:45:19.119,0:45:24.160
doctors receive less for the procedure

0:45:22.319,0:45:25.599
when your provider is medicare because

0:45:24.160,0:45:27.680
it’s being paid out by the government

0:45:25.599,0:45:28.880
but if you have private health insurance

0:45:27.680,0:45:30.240
they’re able to charge your private

0:45:28.880,0:45:31.440
health insurance company more so the

0:45:30.240,0:45:33.359
private health insurance company is

0:45:31.440,0:45:36.160
paying more for the same procedure than

0:45:33.359,0:45:37.839
um a government paid out version of

0:45:36.160,0:45:41.599
medicare

0:45:37.839,0:45:45.119
interesting wow yeah that’s wild

0:45:41.599,0:45:46.560
can you talk about um

0:45:45.119,0:45:48.720
like not to get too volatile but yeah

0:45:46.560,0:45:50.319
can you talk about kind of the pros and

0:45:48.720,0:45:52.960
cons of obamacare

0:45:50.319,0:45:54.240
because one of my friends from spain was

0:45:52.960,0:45:57.520
talking to me

0:45:54.240,0:45:59.200
and he was talking about healthcare this

0:45:57.520,0:46:00.720
is before i had any idea about

0:45:59.200,0:46:03.119
like what the healthcare system is like

0:46:00.720,0:46:04.960
in america he was complaining about the

0:46:03.119,0:46:05.359
american healthcare system and he was

0:46:04.960,0:46:08.480
like

0:46:05.359,0:46:10.720
obamacare i mean spain had that like way

0:46:08.480,0:46:13.760
back in the 1800s

0:46:10.720,0:46:15.520
you guys are so far behind so what was

0:46:13.760,0:46:16.400
obamacare he was saying it was like a

0:46:15.520,0:46:18.400
first step

0:46:16.400,0:46:20.160
towards getting better health care what

0:46:18.400,0:46:22.160
are the pros and cons

0:46:20.160,0:46:24.400
yeah why do people complain about it

0:46:22.160,0:46:25.920
yeah no i think every american has this

0:46:24.400,0:46:26.720
question and obamacare is always thrown

0:46:25.920,0:46:29.200
out there you know

0:46:26.720,0:46:30.640
um and not i mean even i i’m not an

0:46:29.200,0:46:30.960
expert on obamacare i can just sort of

0:46:30.640,0:46:32.960
share

0:46:30.960,0:46:34.880
my own perspective of what obamacare

0:46:32.960,0:46:37.440
brought to the system for us

0:46:34.880,0:46:38.960
but i think like the biggest parts of

0:46:37.440,0:46:42.400
the affordable care act

0:46:38.960,0:46:44.640
is that it expanded coverage

0:46:42.400,0:46:46.720
to i believe over 20 million more

0:46:44.640,0:46:49.599
americans who are uninsured

0:46:46.720,0:46:50.480
were able to apply for health insurance

0:46:49.599,0:46:53.520
coverage

0:46:50.480,0:46:57.280
um because they they

0:46:53.520,0:46:59.680
across all income levels uh

0:46:57.280,0:47:00.640
tried to expand um i think it was

0:46:59.680,0:47:03.599
medicaid

0:47:00.640,0:47:04.160
um and other health insurance uh i guess

0:47:03.599,0:47:07.280
private

0:47:04.160,0:47:08.560
coverages um sorry let me

0:47:07.280,0:47:12.319
back up because i’m trying to like

0:47:08.560,0:47:12.319
organize my thoughts there okay

0:47:12.480,0:47:16.000
yeah that was too wordy um

0:47:16.400,0:47:20.000
oh you got it you’re doing well it’s

0:47:18.400,0:47:21.200
like a lot of good information and i

0:47:20.000,0:47:22.160
think you’re explaining it really well

0:47:21.200,0:47:24.640
too

0:47:22.160,0:47:25.359
okay thank you yeah way better than the

0:47:24.640,0:47:30.400
book oh

0:47:25.359,0:47:30.400
reading the book was like honestly

0:47:31.119,0:47:34.960
okay so i’ll talk about okay yeah i yeah

0:47:34.000,0:47:36.880
so i mean um

0:47:34.960,0:47:38.400
yeah i’m definitely not an expert on the

0:47:36.880,0:47:39.440
affordable care act or obamacare but i

0:47:38.400,0:47:41.280
can just share a little bit of my own

0:47:39.440,0:47:42.400
perspectives on like what it brought

0:47:41.280,0:47:44.240
um and maybe what your friend was

0:47:42.400,0:47:45.839
mentioning in europe so i mean off the

0:47:44.240,0:47:47.599
bat something that comes to mind is

0:47:45.839,0:47:48.880
um i’ve mentioned private health care

0:47:47.599,0:47:52.000
insurance companies

0:47:48.880,0:47:53.440
in germany and france can’t deny

0:47:52.000,0:47:55.920
you coverage based on pre-existing

0:47:53.440,0:47:58.800
conditions um so in the u.s before

0:47:55.920,0:48:00.480
the affordable care act was passed um i

0:47:58.800,0:48:01.920
mean here’s an anecdotal story that was

0:48:00.480,0:48:03.839
shared in tierra reed’s book and

0:48:01.920,0:48:05.119
something that was like very vivid and i

0:48:03.839,0:48:06.480
remember so well because

0:48:05.119,0:48:08.480
it took like i mean i was just like

0:48:06.480,0:48:09.920
blown away that this existed in the us

0:48:08.480,0:48:12.480
but before the affordable care act so

0:48:09.920,0:48:14.720
there was um this woman who was working

0:48:12.480,0:48:15.920
uh she had a great job just outside of

0:48:14.720,0:48:17.280
um just

0:48:15.920,0:48:19.200
outside of undergrad like she was i

0:48:17.280,0:48:22.160
think 23 or 24

0:48:19.200,0:48:24.640
um so she wasn’t covered by her health

0:48:22.160,0:48:26.880
by her parents health care insurance

0:48:24.640,0:48:28.640
she had just gotten a new job so she was

0:48:26.880,0:48:31.359
getting health insurance for her new job

0:48:28.640,0:48:32.960
uh but she was off of her parents health

0:48:31.359,0:48:34.319
insurance so i mean that’s another

0:48:32.960,0:48:36.319
edition of the affordable care act it

0:48:34.319,0:48:38.160
extended coverage on your parents

0:48:36.319,0:48:39.839
health insurance until you’re 26 but

0:48:38.160,0:48:41.599
before it used to be much younger

0:48:39.839,0:48:43.440
um so you dealt with a lot of young

0:48:41.599,0:48:45.680
people who were uninsured

0:48:43.440,0:48:48.000
but anyway so she got this new job but

0:48:45.680,0:48:51.440
then she came down with symptoms

0:48:48.000,0:48:53.680
of lupus and because lupus took a really

0:48:51.440,0:48:55.359
heavy toll on her life she lost her job

0:48:53.680,0:48:57.680
so losing her job she lost her health

0:48:55.359,0:48:58.640
insurance and in europe like i mentioned

0:48:57.680,0:48:59.839
in france and germany

0:48:58.640,0:49:01.440
if this happened to you the government

0:48:59.839,0:49:02.400
would step in and pay your premium for

0:49:01.440,0:49:03.760
you so that you still have health

0:49:02.400,0:49:06.480
insurance for health care

0:49:03.760,0:49:07.200
but in her case she couldn’t be um she

0:49:06.480,0:49:09.040
didn’t have a

0:49:07.200,0:49:10.800
health insurance um so she was paying

0:49:09.040,0:49:14.640
everything out of pocket for care

0:49:10.800,0:49:16.240
um until she was uh or actually so

0:49:14.640,0:49:17.599
sorry the the story she shared is that

0:49:16.240,0:49:18.319
she wasn’t making anything because she

0:49:17.599,0:49:21.839
was laid off

0:49:18.319,0:49:24.880
so she applied for um medicaid

0:49:21.839,0:49:26.240
for low income uh in the u.s and she was

0:49:24.880,0:49:27.200
getting some basic coverage through

0:49:26.240,0:49:29.040
medicaid

0:49:27.200,0:49:30.720
but she was having to go to particular

0:49:29.040,0:49:31.280
doctors who could treat lupus which

0:49:30.720,0:49:33.599
weren’t her

0:49:31.280,0:49:34.400
initial physicians that she was getting

0:49:33.599,0:49:36.000
through

0:49:34.400,0:49:37.440
her employer paid insurance so she had

0:49:36.000,0:49:40.079
to change um

0:49:37.440,0:49:42.000
her provider which had a huge toll on

0:49:40.079,0:49:44.480
sort of figuring out her problem

0:49:42.000,0:49:46.079
and also in her care but once she

0:49:44.480,0:49:47.119
started feeling better she was getting

0:49:46.079,0:49:48.240
the right drugs you know through

0:49:47.119,0:49:51.280
medicaid

0:49:48.240,0:49:52.720
um she ends up getting a job and then

0:49:51.280,0:49:54.559
she makes too much to qualify for

0:49:52.720,0:49:56.079
medicaid so now she’s uninsured again

0:49:54.559,0:49:57.839
so she starts looking for insurance

0:49:56.079,0:49:59.119
companies in the us and and before the

0:49:57.839,0:50:01.119
affordable care act

0:49:59.119,0:50:02.800
um they could deny her coverage based on

0:50:01.119,0:50:04.319
her pre-existing condition of lupus so

0:50:02.800,0:50:06.079
she had to say like i have lupus

0:50:04.319,0:50:07.440
i’m looking to be covered um and the

0:50:06.079,0:50:08.640
insurance company could say i don’t want

0:50:07.440,0:50:09.680
to take you because you’re going to cost

0:50:08.640,0:50:10.960
money

0:50:09.680,0:50:12.000
and so they denied her coverage she

0:50:10.960,0:50:13.119
couldn’t find a private healthcare

0:50:12.000,0:50:14.640
insurance company

0:50:13.119,0:50:16.880
um and i believe she ended up dying very

0:50:14.640,0:50:18.240
young uh before her before she turned

0:50:16.880,0:50:20.800

  1. but i mean like

0:50:18.240,0:50:22.319
something like this um one of the

0:50:20.800,0:50:23.359
european models i don’t think ever would

0:50:22.319,0:50:24.160
have happened because there’s at least

0:50:23.359,0:50:26.079
that basic

0:50:24.160,0:50:27.680
um universal coverage for people to have

0:50:26.079,0:50:29.040
covered those drug costs

0:50:27.680,0:50:30.720
but i mean this is a story before the

0:50:29.040,0:50:31.920
affordable care act so i mean one

0:50:30.720,0:50:33.839
she couldn’t get health insurance

0:50:31.920,0:50:34.480
through her parents because she was too

0:50:33.839,0:50:36.960
old

0:50:34.480,0:50:38.400
uh the affordable care act extended that

0:50:36.960,0:50:40.800
um but also

0:50:38.400,0:50:41.760
now you uh if you can pay for private

0:50:40.800,0:50:43.440
healthcare insurance companies they

0:50:41.760,0:50:45.839
cannot deny you based on pre-existing

0:50:43.440,0:50:47.920
conditions

0:50:45.839,0:50:49.359
the other thing that the affordable care

0:50:47.920,0:50:51.839
act did was expand

0:50:49.359,0:50:53.119
medicaid for tons of lower income

0:50:51.839,0:50:55.119
individuals so i think it may

0:50:53.119,0:50:56.559
expanded for more than 20 million people

0:50:55.119,0:50:58.800
who were uninsured

0:50:56.559,0:51:00.000
um when they applied for the affordable

0:50:58.800,0:51:03.440
care act and

0:51:00.000,0:51:04.880
um were able to to have a marketplace

0:51:03.440,0:51:07.520
for health insurance

0:51:04.880,0:51:08.400
um covering like purchasing their own

0:51:07.520,0:51:10.800
coverage

0:51:08.400,0:51:12.960
i have a question too so i hear a lot of

0:51:10.800,0:51:15.920
complaints over obamacare on an

0:51:12.960,0:51:17.520
increase in taxes for people because

0:51:15.920,0:51:18.640
they feel like they’re paying out for

0:51:17.520,0:51:21.280
obamacare

0:51:18.640,0:51:23.200
now is that true or is the issue lying

0:51:21.280,0:51:25.040
in the fact that there’s privatized

0:51:23.200,0:51:26.960
health insurance companies that can

0:51:25.040,0:51:27.920
control your premium so if they now have

0:51:26.960,0:51:30.240
to cover

0:51:27.920,0:51:31.359
more people who have um higher health

0:51:30.240,0:51:33.040
risks then they

0:51:31.359,0:51:36.079
increase the premium for everyone else

0:51:33.040,0:51:37.520
under the insurance

0:51:36.079,0:51:39.119
yeah that’s i mean that’s a great

0:51:37.520,0:51:39.920
question i always like i think a common

0:51:39.119,0:51:42.319
complaint

0:51:39.920,0:51:43.599
um i don’t know the answer off the top

0:51:42.319,0:51:46.000
my head

0:51:43.599,0:51:47.920
um of how directly they’re impacted by

0:51:46.000,0:51:50.240
like increased taxes for

0:51:47.920,0:51:51.839
the affordable care act uh but i do know

0:51:50.240,0:51:53.359
like when it expanded coverage

0:51:51.839,0:51:54.880
i mean more people are being covered

0:51:53.359,0:51:56.400
under this this program that’s being

0:51:54.880,0:51:59.440
paid out by the government

0:51:56.400,0:52:01.440
uh but i mean i think the response my

0:51:59.440,0:52:04.800
own response is just my opinion

0:52:01.440,0:52:05.440
um is that like i’d rather pay higher

0:52:04.800,0:52:07.680
taxes

0:52:05.440,0:52:09.760
now um than have to pay out of pocket

0:52:07.680,0:52:11.200
later uh when you do need the care so i

0:52:09.760,0:52:12.319
mean if you have like a system that is

0:52:11.200,0:52:13.520
covering that

0:52:12.319,0:52:15.359
might as well pay it all up front

0:52:13.520,0:52:17.040
because us still ends up paying

0:52:15.359,0:52:19.040
nearly twice of what other countries are

0:52:17.040,0:52:21.119
paying per person

0:52:19.040,0:52:22.000
uh every year but it’s in hidden costs

0:52:21.119,0:52:23.599
that you don’t think about like

0:52:22.000,0:52:26.800
prescription drugs or

0:52:23.599,0:52:27.200
um co-pays and things like that yeah i

0:52:26.800,0:52:29.359
agree

0:52:27.200,0:52:31.280
i think i’m already paying a ridiculous

0:52:29.359,0:52:34.160
amount for my health care and it’s

0:52:31.280,0:52:35.680
if i were to lose my job and if before

0:52:34.160,0:52:37.359
the affordable care act and i lost

0:52:35.680,0:52:38.319
insurance as well and i lost health

0:52:37.359,0:52:39.920
coverage it’s like

0:52:38.319,0:52:43.040
what was all that money that i was

0:52:39.920,0:52:47.839
paying before like where did that go

0:52:43.040,0:52:47.839
yeah yeah that’s frustrating

0:52:48.400,0:52:53.839
yeah i would like man like

0:52:51.839,0:52:55.200
i think you mentioned it earlier but i

0:52:53.839,0:52:57.839
think just a lot of

0:52:55.200,0:52:59.520
americans don’t really go to the doctors

0:52:57.839,0:53:03.200
or go to the hospital

0:52:59.520,0:53:05.359
um like for preventative measures uh

0:53:03.200,0:53:06.720
like i only go to the doctors like if

0:53:05.359,0:53:08.400
it’s an emergency

0:53:06.720,0:53:11.040
and that was the biggest culture shock

0:53:08.400,0:53:12.960
for me coming to south korea

0:53:11.040,0:53:14.720
like here it’s just so much more

0:53:12.960,0:53:16.240
affordable so people just go to the

0:53:14.720,0:53:18.960
hospital like

0:53:16.240,0:53:21.119
all the time i know a really common

0:53:18.960,0:53:22.160
thing is people will go to the hospital

0:53:21.119,0:53:24.000
to get like iv

0:53:22.160,0:53:26.000
treatment if they’re really hungover and

0:53:24.000,0:53:28.240
like it’s like

0:53:26.000,0:53:29.680
anything so like yeah i would just like

0:53:28.240,0:53:31.280
my friends would just be like oh yeah i

0:53:29.680,0:53:33.920
was in the hospital this morning and

0:53:31.280,0:53:36.240
it’s like to me like that’s just such a

0:53:33.920,0:53:38.480
it was just really shocking to see how

0:53:36.240,0:53:41.920
convenient and how affordable

0:53:38.480,0:53:43.040
healthcare is yeah no i totally agree my

0:53:41.920,0:53:45.119
friend in the uk

0:53:43.040,0:53:46.960
um yeah i know she’s shocked when she

0:53:45.119,0:53:48.319
says like you receive a bill for your

0:53:46.960,0:53:50.000
emergency room visit

0:53:48.319,0:53:51.440
like i’ve never received a bill in my

0:53:50.000,0:53:52.880
life for health care but

0:53:51.440,0:53:54.319
i mean she says it does lead to like

0:53:52.880,0:53:55.200
overuse of the system sometimes where

0:53:54.319,0:53:58.079
people just show up in

0:53:55.200,0:53:59.680
um sort of like the comparable to our

0:53:58.079,0:54:01.440
urgent care with things that i mean

0:53:59.680,0:54:04.640
could be taken care of at home

0:54:01.440,0:54:06.400
um but for the most part i mean

0:54:04.640,0:54:08.480
uh everyone is covered so i mean

0:54:06.400,0:54:09.119
something like that anecdote i just

0:54:08.480,0:54:10.559
shared

0:54:09.119,0:54:11.920
of the woman with lupus like that

0:54:10.559,0:54:14.319
probably would never have happened in

0:54:11.920,0:54:15.520
somewhere like the uk

0:54:14.319,0:54:16.720
um and you know talking about

0:54:15.520,0:54:17.680
preventative care in the u.s i think

0:54:16.720,0:54:20.000
that’s one of our biggest

0:54:17.680,0:54:21.200
issues um right now in our health care

0:54:20.000,0:54:23.920
system is that

0:54:21.200,0:54:25.440
um it’s it sort of like limits access

0:54:23.920,0:54:26.880
for a lot of people but i mean even

0:54:25.440,0:54:27.839
people with health insurance companies i

0:54:26.880,0:54:29.440
mean co-pays that’s what they’re

0:54:27.839,0:54:30.559
supposed to do deter you from overusing

0:54:29.440,0:54:33.520
the system

0:54:30.559,0:54:33.839
um but you have people who i mean have a

0:54:33.520,0:54:35.920
an

0:54:33.839,0:54:37.040
um i mean they have an ear infection and

0:54:35.920,0:54:37.680
they’re like i don’t really want to pay

0:54:37.040,0:54:38.960
the 40

0:54:37.680,0:54:40.880
copay i want to go to urgent care right

0:54:38.960,0:54:42.559
now it’ll get better i mean i’ve seen

0:54:40.880,0:54:43.760
this i mean even shadowing physicians

0:54:42.559,0:54:45.359
where a woman who had an

0:54:43.760,0:54:47.119
ear infection didn’t go because she

0:54:45.359,0:54:48.960
didn’t want to pay the 40 copay

0:54:47.119,0:54:51.280
um it ended up turning into a septic

0:54:48.960,0:54:53.440
infection which is lethal

0:54:51.280,0:54:54.640
and had to get like tens of thousands of

0:54:53.440,0:54:56.319
dollars in care

0:54:54.640,0:54:58.240
um when she could have just paid the 40

0:54:56.319,0:55:00.400
copay gotten some antibiotics

0:54:58.240,0:55:02.319
um and likely killed the infection

0:55:00.400,0:55:04.480
before it it uh

0:55:02.319,0:55:06.000
was infecting her bloodstream so i mean

0:55:04.480,0:55:06.640
there are cases like this in the us

0:55:06.000,0:55:08.480
where yeah

0:55:06.640,0:55:09.680
preventative care really isn’t at the

0:55:08.480,0:55:12.480
forefront of

0:55:09.680,0:55:13.440
our values or or something like that but

0:55:12.480,0:55:14.480
i mean

0:55:13.440,0:55:16.400
since we’re comparing all these

0:55:14.480,0:55:17.599
countries uh it’s it’s important to

0:55:16.400,0:55:19.599
mention too i mean like even health

0:55:17.599,0:55:21.440
insurance companies in germany in in

0:55:19.599,0:55:23.040
france so germany’s like competition

0:55:21.440,0:55:24.640
between insurance companies is

0:55:23.040,0:55:26.000
sort of benefits of what they can offer

0:55:24.640,0:55:27.680
people who join their insurance company

0:55:26.000,0:55:29.680
so in germany i feel like

0:55:27.680,0:55:31.119
i think they they offer perks based on

0:55:29.680,0:55:33.040
your preventative care so if you

0:55:31.119,0:55:34.799
go to the doctor at least once a year

0:55:33.040,0:55:36.240
you reserve a certain amount of reward

0:55:34.799,0:55:39.280
points or something

0:55:36.240,0:55:39.920
um which are paid out in like uh i don’t

0:55:39.280,0:55:41.680
know maybe

0:55:39.920,0:55:42.960
some sort of gift card compensation or

0:55:41.680,0:55:45.040
something like that

0:55:42.960,0:55:46.400
um but yeah but i mean for the

0:55:45.040,0:55:47.680
healthcare insurance company it’s very

0:55:46.400,0:55:48.319
low you’re paying a i mean you’re paying

0:55:47.680,0:55:50.799
like a

0:55:48.319,0:55:52.160
600 premium a month and they’re giving

0:55:50.799,0:55:53.440
out these small incentives but i mean

0:55:52.160,0:55:54.079
it’s all preventative care so they’re

0:55:53.440,0:55:55.920
going to catch

0:55:54.079,0:55:58.559
they’re going to catch something before

0:55:55.920,0:55:59.839
you end up developing a septic infection

0:55:58.559,0:56:01.359
and the health insurance company has to

0:55:59.839,0:56:02.240
pay out thousands of dollars for that

0:56:01.359,0:56:03.520
versus just

0:56:02.240,0:56:04.720
getting you those antibiotics when you

0:56:03.520,0:56:06.240
need them so i mean it keeps costs slow

0:56:04.720,0:56:08.400
for them as well

0:56:06.240,0:56:09.359
wait tea on that have you guys seen the

0:56:08.400,0:56:12.640
tlc show

0:56:09.359,0:56:14.559
dr pimple popper yes i love that show

0:56:12.640,0:56:16.559
bruh like i was thinking about it the

0:56:14.559,0:56:17.680
reason why these people are coming in

0:56:16.559,0:56:19.680
with

0:56:17.680,0:56:20.880
um for lack of a better word like these

0:56:19.680,0:56:24.079
extreme

0:56:20.880,0:56:26.000
skin problems is because they were

0:56:24.079,0:56:27.680
probably uninsured or they were scared

0:56:26.000,0:56:29.760
to go to the doctor to get it figured

0:56:27.680,0:56:30.000
out when it was a small issue and now

0:56:29.760,0:56:33.599
it’s

0:56:30.000,0:56:33.920
like huge and yeah but i mean that’s how

0:56:33.599,0:56:36.880
we

0:56:33.920,0:56:38.720
got dr ripple popper so yeah so i guess

0:56:36.880,0:56:41.680
like what is the solution

0:56:38.720,0:56:44.720
to the healthcare issue in the us yeah

0:56:41.680,0:56:46.480
what’s your opinion

0:56:44.720,0:56:47.920
great question something i’m like always

0:56:46.480,0:56:49.920
thinking about and

0:56:47.920,0:56:51.520
um i mean solutions are offered by t

0:56:49.920,0:56:53.040
read in his book the healing of america

0:56:51.520,0:56:54.000
as well which a lot of my opinions come

0:56:53.040,0:56:56.559
from

0:56:54.000,0:56:57.520
um but i think i mean the main issues in

0:56:56.559,0:57:00.160
the us right now is

0:56:57.520,0:57:01.440
we we have lower health outcomes um in

0:57:00.160,0:57:02.880
comparison to these other

0:57:01.440,0:57:05.280
richer countries who have other health

0:57:02.880,0:57:06.799
care systems um and we also are paying

0:57:05.280,0:57:07.359
twice of what they’re paying so it’s

0:57:06.799,0:57:09.119
like

0:57:07.359,0:57:11.359
how do we reduce costs and how do we

0:57:09.119,0:57:12.880
extend um

0:57:11.359,0:57:14.160
health outcomes in our own system when

0:57:12.880,0:57:15.040
we’re one of the richest countries with

0:57:14.160,0:57:16.799
the best

0:57:15.040,0:57:18.240
medical providers the best sort of

0:57:16.799,0:57:20.079
scientific research going on in

0:57:18.240,0:57:23.040
innovation and therapeutics

0:57:20.079,0:57:24.480
um and i think i think it just plays

0:57:23.040,0:57:26.559
back to the beginning where like it’s

0:57:24.480,0:57:27.599
very expensive maintaining so many

0:57:26.559,0:57:31.440
different systems

0:57:27.599,0:57:31.920
in the us um where it creates a system

0:57:31.440,0:57:33.839
that’s

0:57:31.920,0:57:34.720
kind of like a mystery like you don’t

0:57:33.839,0:57:35.920
know how much you’re going to pay for a

0:57:34.720,0:57:37.440
procedure you don’t know

0:57:35.920,0:57:38.960
who’s covered by what procedure because

0:57:37.440,0:57:41.839
it’s just very confusing

0:57:38.960,0:57:42.960
on who’s providing the care um and who’s

0:57:41.839,0:57:46.240
paying for it

0:57:42.960,0:57:47.839
um so i mean i think going forward um

0:57:46.240,0:57:49.680
it’s very important that we have like a

0:57:47.839,0:57:50.960
set priceless of how much the bill will

0:57:49.680,0:57:51.920
be so there’s like that that

0:57:50.960,0:57:53.839
standardized

0:57:51.920,0:57:55.280
cost and transparency transparency

0:57:53.839,0:57:56.319
aspect um

0:57:55.280,0:57:59.040
this is something that’s been rolled

0:57:56.319,0:58:02.480
down in countries like france and japan

0:57:59.040,0:58:04.400
um and i guess uh just the thing about

0:58:02.480,0:58:05.680
going toward like a single-payer

0:58:04.400,0:58:07.040
healthcare system in the us which is a

0:58:05.680,0:58:08.000
lot of what’s talked about in politics

0:58:07.040,0:58:09.760
right now

0:58:08.000,0:58:11.680
um is that lobbying groups and

0:58:09.760,0:58:14.319
healthcare companies set priorities

0:58:11.680,0:58:15.839
right now for a single-payer system so

0:58:14.319,0:58:16.640
it’s maybe something that we won’t see

0:58:15.839,0:58:18.720
very soon

0:58:16.640,0:58:20.400
um but i think just one system that

0:58:18.720,0:58:21.599
allows you to create a transparent cost

0:58:20.400,0:58:26.000
and charge schedule

0:58:21.599,0:58:27.680
as well as um making the like

0:58:26.000,0:58:29.040
decision that we want to cover every

0:58:27.680,0:58:30.160
single person living in the united

0:58:29.040,0:58:33.440
states one way or one

0:58:30.160,0:58:34.960
like somewhere somehow is very important

0:58:33.440,0:58:36.559
um and i think what’s very important for

0:58:34.960,0:58:37.680
me in healthcare is really expanding

0:58:36.559,0:58:39.520
coverage to everyone

0:58:37.680,0:58:41.599
at least having a system that’s able to

0:58:39.520,0:58:42.960
provide universal healthcare coverage

0:58:41.599,0:58:45.119
across the board

0:58:42.960,0:58:46.000
um and i think one of the the solutions

0:58:45.119,0:58:47.440
in politics

0:58:46.000,0:58:50.000
talked about right now is to expand

0:58:47.440,0:58:52.240
medicare for all you may hear that a lot

0:58:50.000,0:58:54.640
that’s essentially uh having the

0:58:52.240,0:58:57.760
government cover all adult 65 plus

0:58:54.640,0:58:59.040
and below 18 but then allowing adults to

0:58:57.760,0:59:00.880
buy into the program

0:58:59.040,0:59:04.160
so the government would be essentially

0:59:00.880,0:59:06.079
paying for your your care

0:59:04.160,0:59:08.079
but i assume that care would still go on

0:59:06.079,0:59:09.359
being provided by private

0:59:08.079,0:59:10.480
physicians and things like that but

0:59:09.359,0:59:11.760
there would be a more transparent

0:59:10.480,0:59:13.359
schedule

0:59:11.760,0:59:14.960
so it would maintain coverage at a lot

0:59:13.359,0:59:16.480
of participating hospitals

0:59:14.960,0:59:19.520
but it would also allow for easier

0:59:16.480,0:59:21.760
access to health care options

0:59:19.520,0:59:22.799
and i think it’s just like a transition

0:59:21.760,0:59:25.680
to one sort of

0:59:22.799,0:59:26.960
system or model so it might not reduce

0:59:25.680,0:59:27.520
costs immediately but i guess we won’t

0:59:26.960,0:59:30.559
know

0:59:27.520,0:59:31.839
until it’s in practice

0:59:30.559,0:59:34.079
i think that’s the hard thing about the

0:59:31.839,0:59:37.119
us health care reform is that

0:59:34.079,0:59:38.640
no one knows really what to do

0:59:37.119,0:59:39.920
just final thoughts i give a lot of my

0:59:38.640,0:59:41.440
background knowledge and a lot of like

0:59:39.920,0:59:43.119
my opinions sort of on

0:59:41.440,0:59:45.040
the book by tree and a lot of what i’ve

0:59:43.119,0:59:45.599
watched him uh talk because he travels

0:59:45.040,0:59:46.640
across

0:59:45.599,0:59:49.040
the world you know to learn these

0:59:46.640,0:59:51.200
systems um so if you want to know more

0:59:49.040,0:59:52.400
highly recommend the book um and highly

0:59:51.200,0:59:54.400
recommend just looking up on

0:59:52.400,0:59:55.920
looking him up on youtube you may have

0:59:54.400,0:59:58.480
you’ll hear an overlap of a lot of what

0:59:55.920,0:59:58.480
i’ve said today

0:59:59.359,1:00:02.720
well thank you so much for sharing that

1:00:01.520,1:00:04.640
was like really

1:00:02.720,1:00:06.400
really incredible you did a really great

1:00:04.640,1:00:07.359
job at giving us such a comprehensive

1:00:06.400,1:00:10.319
overview of

1:00:07.359,1:00:12.480
literally healthcare around the entire

1:00:10.319,1:00:14.799
entire world it’s like

1:00:12.480,1:00:16.079
man yeah that was really good thank you

1:00:14.799,1:00:18.079
so much for

1:00:16.079,1:00:19.680
sharing because it makes more sense now

1:00:18.079,1:00:20.480
i always thought like healthcare like oh

1:00:19.680,1:00:22.720
it’s

1:00:20.480,1:00:23.520
so confusing i don’t understand anything

1:00:22.720,1:00:26.799
but

1:00:23.520,1:00:28.880
yeah the problem i feel like the

1:00:26.799,1:00:30.559
healthcare issue in the u.s is really

1:00:28.880,1:00:33.280
complex but when you break it down

1:00:30.559,1:00:34.079
into just like the basics it’s a lot

1:00:33.280,1:00:37.280
easier to

1:00:34.079,1:00:38.640
understand and digest absolutely i think

1:00:37.280,1:00:41.119
this is a big

1:00:38.640,1:00:42.960
how did we not know that episode like

1:00:41.119,1:00:44.079
how did we literally not know

1:00:42.960,1:00:46.000
and it’s one of those things that i

1:00:44.079,1:00:47.520
don’t think like we know growing up as

1:00:46.000,1:00:48.160
children because we don’t worry about it

1:00:47.520,1:00:50.400
but

1:00:48.160,1:00:52.160
after i got my first job and then i’m

1:00:50.400,1:00:53.359
paying for my healthcare and i’m paying

1:00:52.160,1:00:54.880
for my care now

1:00:53.359,1:00:56.720
it’s just ridiculous and i was

1:00:54.880,1:00:58.240
complaining to my mom about how

1:00:56.720,1:00:59.920
expensive health care is

1:00:58.240,1:01:02.240
she was like what do you think our

1:00:59.920,1:01:03.839
premium was per month like what did you

1:01:02.240,1:01:07.280
think our deductible was it’s

1:01:03.839,1:01:09.200
thousands of dollars was like

1:01:07.280,1:01:10.559
this is why like i tell you if you’re

1:01:09.200,1:01:12.640
sick taking a leave

1:01:10.559,1:01:13.839
and sleep like you’re not going to the

1:01:12.640,1:01:15.280
doctors

1:01:13.839,1:01:16.480
yeah no i totally agree it’s something

1:01:15.280,1:01:17.839
that you don’t start to think about

1:01:16.480,1:01:19.280
until you’re sort of like

1:01:17.839,1:01:20.720
making the transition to adulthood and

1:01:19.280,1:01:22.079
then you’re like oh this is slapping me

1:01:20.720,1:01:24.480
in the face like i didn’t know any of

1:01:22.079,1:01:26.799
this existed or how it works right yeah

1:01:24.480,1:01:29.760
esteban thank you so much for being our

1:01:26.799,1:01:31.920
guest we really are happy to have you

1:01:29.760,1:01:33.520
thank you guys for having me um i hope i

1:01:31.920,1:01:36.559
was qualified enough to

1:01:33.520,1:01:37.599
talk a lot about the topics today oh

1:01:36.559,1:01:41.280
absolutely i’m

1:01:37.599,1:01:41.280
excited to have been here so thanks for

1:01:47.000,1:01:50.000
that

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