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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.
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“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 .
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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.
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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.
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Transcript
0:00:00.080,0:00:05.040 hello everybody and welcome back to
0:00:02.639,0:00:05.759 another episode of how did we not know
0:00:05.040,0:00:09.679 that
0:00:05.759,0:00:12.799 i’m nat i’m jack and i’m esteban
0:00:09.679,0:00:14.880 yay hi everyone today we have a very
0:00:12.799,0:00:18.000 special guest it’s my very good friend
0:00:14.880,0:00:20.880 esteban and he will be presenting on
0:00:18.000,0:00:21.520 healthcare around the world right that’s
0:00:20.880,0:00:22.880 right yeah
0:00:21.520,0:00:24.960 talking a little bit about different
0:00:22.880,0:00:25.840 healthcare systems across the globe and
0:00:24.960,0:00:28.400 especially something that’s like
0:00:25.840,0:00:31.679 relevant to the united states as well so
0:00:28.400,0:00:33.120 okay yeah so i guess um we can start at
0:00:31.679,0:00:33.440 the very beginning for people who don’t
0:00:33.120,0:00:35.680 know
0:00:33.440,0:00:36.640 sort of what a healthcare system is um
0:00:35.680,0:00:38.559 so
0:00:36.640,0:00:40.079 uh just doing some basic research and
0:00:38.559,0:00:41.760 sort of my own background knowledge
0:00:40.079,0:00:43.840 uh so healthcare system really is
0:00:41.760,0:00:45.120 composed of really three things and so
0:00:43.840,0:00:46.399 first you have providers
0:00:45.120,0:00:48.640 or medical providers who are actually
0:00:46.399,0:00:50.079 providing your care the second is really
0:00:48.640,0:00:51.760 the population of the people who are
0:00:50.079,0:00:54.239 taking advantage of that care
0:00:51.760,0:00:55.039 and then three is really insurers or
0:00:54.239,0:00:57.520 who’s paying
0:00:55.039,0:00:59.440 for uh your health care um so those
0:00:57.520,0:01:02.399 those three things really make up
0:00:59.440,0:01:02.960 a comprehensive health care system and
0:01:02.399,0:01:04.479 um
0:01:02.960,0:01:06.479 i guess something off the bat that
0:01:04.479,0:01:08.320 people might be familiar with seeing on
0:01:06.479,0:01:10.720 health insurance cards um are the
0:01:08.320,0:01:13.280 abbreviations hmo and ppo
0:01:10.720,0:01:14.640 um so in the united states we have um
0:01:13.280,0:01:15.600 those two abbreviations for insurer
0:01:14.640,0:01:17.680 providers
0:01:15.600,0:01:19.280 uh but i can just sort of go into the
0:01:17.680,0:01:22.479 the basics of what those two
0:01:19.280,0:01:24.400 uh differences mean um so
0:01:22.479,0:01:25.759 uh if you’ve ever seen hmo written on
0:01:24.400,0:01:26.799 your health insurance card it really
0:01:25.759,0:01:27.920 stands for health maintenance
0:01:26.799,0:01:30.320 organization
0:01:27.920,0:01:31.840 um and so they actually uh cover your
0:01:30.320,0:01:34.159 care by integrating with
0:01:31.840,0:01:35.280 uh private providers so an example is
0:01:34.159,0:01:37.439 like kaiser
0:01:35.280,0:01:39.040 uh an insurance company but you still
0:01:37.439,0:01:40.320 you pay them the premium
0:01:39.040,0:01:42.079 and they sort of like give you a set
0:01:40.320,0:01:43.759 list of doctors that you can see
0:01:42.079,0:01:45.680 but if you don’t see these doctors you
0:01:43.759,0:01:47.759 have to pay out of pocket for your care
0:01:45.680,0:01:49.200 um and then the other sort of big
0:01:47.759,0:01:51.119 insurance type of company
0:01:49.200,0:01:53.439 in the united states is a preferred
0:01:51.119,0:01:55.280 provider organization or ppo
0:01:53.439,0:01:56.719 um so you still get that list of doctors
0:01:55.280,0:01:58.719 that you can
0:01:56.719,0:02:00.240 try to see but your flexibility is
0:01:58.719,0:02:02.399 greater so the list isn’t
0:02:00.240,0:02:03.920 mandatory and the insurance would still
0:02:02.399,0:02:05.360 cover a portion of it if you do decide
0:02:03.920,0:02:06.479 to go to a physician that’s really not
0:02:05.360,0:02:08.560 on their list of
0:02:06.479,0:02:10.640 of doctors so those are really like to
0:02:08.560,0:02:11.760 the big differences in the insurer types
0:02:10.640,0:02:13.760 that we have in the united states and
0:02:11.760,0:02:16.000 what composes our own health care system
0:02:13.760,0:02:20.640 so it’s just a brief introduction
0:02:16.000,0:02:23.280 okay um with like the ppo versus hmo
0:02:20.640,0:02:24.720 when you get to decide which type you
0:02:23.280,0:02:27.360 have is it just based on what your
0:02:24.720,0:02:29.120 employer chose for you
0:02:27.360,0:02:30.480 great question yeah and i think it’s
0:02:29.120,0:02:32.720 really based on
0:02:30.480,0:02:34.720 um what your employer is willing to pay
0:02:32.720,0:02:36.879 or help pay the premium for
0:02:34.720,0:02:38.800 so i think it really depends on employer
0:02:36.879,0:02:39.200 but also i mean if you’re self-employed
0:02:38.800,0:02:40.640 or
0:02:39.200,0:02:42.400 even unemployed and looking for health
0:02:40.640,0:02:45.760 insurance um these are two
0:02:42.400,0:02:45.760 two different types that you might see
0:02:46.640,0:02:50.400 so what is medicaid under is that gonna
0:02:48.480,0:02:51.760 be hmo or ppo
0:02:50.400,0:02:55.280 oh my gosh that’s a good question i
0:02:51.760,0:02:57.440 don’t know probably ppo right because
0:02:55.280,0:02:58.319 yeah so actually these are i think more
0:02:57.440,0:03:01.440 relevant to
0:02:58.319,0:03:02.640 um insurance providers so like medicare
0:03:01.440,0:03:04.000 medicaid is actually
0:03:02.640,0:03:06.480 something that we can get into a little
0:03:04.000,0:03:07.200 bit in the future of talking together
0:03:06.480,0:03:08.640 because
0:03:07.200,0:03:10.239 that’s almost like a completely
0:03:08.640,0:03:11.360 different model of providing healthcare
0:03:10.239,0:03:13.680 so these are really like
0:03:11.360,0:03:14.480 insurance companies provide care right
0:03:13.680,0:03:16.959 uh
0:03:14.480,0:03:18.640 and pay for it um sort of the connection
0:03:16.959,0:03:20.480 between the people and the providers
0:03:18.640,0:03:21.920 but medicare and medicaid are sort of
0:03:20.480,0:03:23.280 related directly just to the government
0:03:21.920,0:03:23.760 so the government is the one actually
0:03:23.280,0:03:26.959 paying
0:03:23.760,0:03:28.640 not the insurance company okay so then
0:03:26.959,0:03:31.920 is this unique to the united
0:03:28.640,0:03:32.799 states health care system yeah great
0:03:31.920,0:03:36.000 question so
0:03:32.799,0:03:38.159 uh we can talk about some
0:03:36.000,0:03:39.360 models that i’ve read a lot about in the
0:03:38.159,0:03:40.720 new book uh
0:03:39.360,0:03:43.040 that i recently read called the healing
0:03:40.720,0:03:45.680 of america by t.r reed so
0:03:43.040,0:03:47.040 he gives a great sort of overview of
0:03:45.680,0:03:48.000 different healthcare systems across the
0:03:47.040,0:03:49.680 globe
0:03:48.000,0:03:50.720 but no this isn’t really i guess unique
0:03:49.680,0:03:52.080 to the united states like there are
0:03:50.720,0:03:53.200 definitely insurance companies in other
0:03:52.080,0:03:54.720 countries
0:03:53.200,0:03:56.319 and we can talk about how they’ve sort
0:03:54.720,0:03:58.000 of integrated that into a healthcare
0:03:56.319,0:03:59.200 system and model for their own countries
0:03:58.000,0:04:00.879 and how it works
0:03:59.200,0:04:02.640 oh yeah i mentioned uh the book the
0:04:00.879,0:04:04.799 healing of america by t.r reed
0:04:02.640,0:04:07.599 um and if if you look up tr read on
0:04:04.799,0:04:09.200 youtube i mean he’s a great sort of
0:04:07.599,0:04:11.040 speaker about health care systems across
0:04:09.200,0:04:12.720 the globe and and really
0:04:11.040,0:04:14.080 sort of helping you gain a better
0:04:12.720,0:04:15.120 perspective of what you think is the
0:04:14.080,0:04:17.759 best choice for
0:04:15.120,0:04:19.359 america going forward but he started one
0:04:17.759,0:04:20.560 of his recent videos that i watched with
0:04:19.359,0:04:22.800 a quote from
0:04:20.560,0:04:24.080 a president who won election and the
0:04:22.800,0:04:25.919 quote goes
0:04:24.080,0:04:27.520 a nation as prosperous and successful as
0:04:25.919,0:04:28.080 ours must guarantee the health of all of
0:04:27.520,0:04:30.080 its men
0:04:28.080,0:04:32.240 and women safeguarding health care for
0:04:30.080,0:04:35.520 every american is not a sentimental wish
0:04:32.240,0:04:37.280 it’s a matter of justice and you may
0:04:35.520,0:04:39.280 think that that sounds like
0:04:37.280,0:04:40.320 a presidential candidate that i mean
0:04:39.280,0:04:42.560 should should have been
0:04:40.320,0:04:43.759 in the running really recently but that
0:04:42.560,0:04:46.160 was actually said by woodward
0:04:43.759,0:04:47.600 woodrow wilson in 1912 um in his
0:04:46.160,0:04:50.080 election for president
0:04:47.600,0:04:51.759 so it’s like not common that i mean
0:04:50.080,0:04:54.000 sorry not uncommon that um
0:04:51.759,0:04:55.840 americans have sort of been vying for a
0:04:54.000,0:04:57.120 health care system that covers every
0:04:55.840,0:04:58.880 single person
0:04:57.120,0:05:00.639 um in trying to recognize that it’s sort
0:04:58.880,0:05:02.639 of a moral dilemma that everyone
0:05:00.639,0:05:05.919 deserves access to health care
0:05:02.639,0:05:07.360 um but there are a series of uh
0:05:05.919,0:05:10.000 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
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