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How Health Care in the United States Works Right Now · Stuff You Should Know

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Speaker 1: Brought to you by the reinvented two thousand twelve camera.
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Speaker 1: It's ready. Are you welcome to Stuff you Should Know?
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Speaker 1: From House Stuff Works dot Com? Hey, and welcome to
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Speaker 1: the podcast. I'm Josh Clark with me as always as
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Speaker 1: Mr Charles W. Chuck Bryant Head and Chuck Well said,
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Speaker 1: good well, it's a good good word it is for
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Speaker 1: this show. This is Stuff you Should Know, And actually
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Speaker 1: this is a special edition of Stuff You Should Know,
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Speaker 1: part one of a four part series. Yes, should I
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Speaker 1: break it? Health care? Health care reform. Everyone seems to
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Speaker 1: be really confused about what lies ahead in the United
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Speaker 1: States and our health care system. It's so confusing, Chuck
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Speaker 1: that I'm not even certain if healthcare is spelled as
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Speaker 1: one word or two. That's pretty much the level that
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Speaker 1: we're at an understanding the idea of health care, let
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Speaker 1: alone healthcare reform. Right, So we're trying to figure this
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Speaker 1: out and along with you guys, and maybe you can
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Speaker 1: learn something here. Yeah. So, um, I guess let's kick
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Speaker 1: it off. Let's get this ball rolling. Yeah, we're gonna
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Speaker 1: We're not gonna talk about future plans. We're gonna talk
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Speaker 1: about how it is today. Yeah. Well, in this podcast
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Speaker 1: in this edition, in this edition, Part one of four,
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Speaker 1: Part one of four. Yeah, it's about the current health
1:19
Speaker 1: care system in the United States. And Chuck, have you
1:22
Speaker 1: ever gone without health insurance? Yeah? How long? Oh? Man?
1:28
Speaker 1: I seem to think that after my parents. Uh see,
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Speaker 1: I think it's the familiar story for everyone, sometime around
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Speaker 1: after college until I got my first real job, which
1:39
Speaker 1: was at least seven or eight years later. Yeah, I
1:42
Speaker 1: think I did a decade. Yeah, same same story, And
1:45
Speaker 1: the parents are always on you, you know, like, oh,
1:46
Speaker 1: you know if you had an accident, and I was like,
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Speaker 1: I'm yeah, exactly, And luckily it worked out the same here.
1:53
Speaker 1: I don't think it works out quite so well for everybody,
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Speaker 1: but sadly you and I are lead charmed lives. Uh.
2:00
Speaker 1: I guess we'll get to the uninsured soon enough. So Chuck,
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Speaker 1: let's go back to the beginning nineteen twenties. In Texas,
2:06
Speaker 1: a guy named Justin Kimball, uh founded a company named
2:10
Speaker 1: Blue Cross still around to day. As I understand, we share.
2:14
Speaker 1: We understand because they have a floor right below us.
2:16
Speaker 1: I believe that's right. That's where I've heard that name before.
2:19
Speaker 1: We shared building. So he started an insurance UM a
2:22
Speaker 1: program plan where UM women contributed. I think teachers specifically
2:28
Speaker 1: contributed fifty cents out of every paycheck UM toward their
2:32
Speaker 1: eventual maternity needs. Right, so when they went to the
2:36
Speaker 1: hospital to have a baby, they were already prepaid. It's
2:38
Speaker 1: not really insurance prepaid plan, but there was something that
2:44
Speaker 1: came out of it that really gave birth to the
2:46
Speaker 1: insurance industry in the US. If you'll forgive the metaphor, um,
2:53
Speaker 1: not all of these teachers had kids, so you could
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Speaker 1: actually make money selling premium selling policies to people because
3:03
Speaker 1: not everybody's going to get cancer. And that's how the
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Speaker 1: whole system still works today. It's a gamble, you know.
3:10
Speaker 1: Ned Flanders once said on The Simpsons, actually wasn't Ned
3:13
Speaker 1: Maud Flanders was explaining Med's position that UM they don't
3:17
Speaker 1: have any kind of insurance because Ned considers it a
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Speaker 1: form of gambling. And it really is. On one side view,
3:24
Speaker 1: the insured are betting that at some point in time,
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Speaker 1: some injury or illness is going to befall you, that's
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Speaker 1: going to cost more to treat than you've put in
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Speaker 1: in monthly payments towards your policy. It is total gambling.
3:38
Speaker 1: The insurance company, on the other hand, is betting that
3:41
Speaker 1: you will be hit by a bus and die immediately,
3:44
Speaker 1: something along those lines where you're not going to need
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Speaker 1: any kind of care, right, or that you just lead
3:48
Speaker 1: a healthy life and nothing nothing happens to you, which
3:52
Speaker 1: is not gonna clearly not gonna happen. I think the
3:54
Speaker 1: hit by the bus scenarios the absolute best that can
3:58
Speaker 1: happen for a insurance company. But so, yeah, it's a
4:01
Speaker 1: form of gambling and you're going head to head with
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Speaker 1: the insurance company, and sometimes it pays off, sometimes it doesn't.
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Speaker 1: But for the most part it it's a pretty good
4:12
Speaker 1: system basically speaking. Yeah, and you pay for peace of
4:15
Speaker 1: mind a lot of times. Is what a lot of
4:17
Speaker 1: people say. You know, he sounds like a chill That
4:21
Speaker 1: sounds like I'm selling interest. I believe that was from
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Speaker 1: Barton Fink. It was John Goodman said that he sells
4:26
Speaker 1: peace of mind. Nice. Well, Chuck, let's fast forward a
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Speaker 1: little bit. By the nineteen forties, UM companies had already
4:35
Speaker 1: begun offering employer uh space insurance plans. Yeah, it's a
4:43
Speaker 1: great incentive to get the best and the brightest, definitely,
4:47
Speaker 1: and actually still is because of this business, which is
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Speaker 1: a sector of US society obviously part of the economy,
4:53
Speaker 1: which is what I wanted to say. But business is
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Speaker 1: a sector just like you know, populations of sector, governments
4:59
Speaker 1: of sector, that kind of thing. Um business said we're
5:02
Speaker 1: going to take the burden of healthcare on our shoulders. Yeah.
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Speaker 1: In ninety three, the i r S supported this and
5:11
Speaker 1: encouraged it with a ruling that said, UM, employers can
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Speaker 1: pay for these programs, these plans for their employees out
5:20
Speaker 1: of pretext dollars, which makes the whole thing really attractive.
5:23
Speaker 1: And all of a sudden, the U S has what
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Speaker 1: amounts to a state sanctioned employer healthcare system, right, and
5:32
Speaker 1: which still thrives today, which is good, same pretax dollars,
5:36
Speaker 1: same deal with I R S. The chances are good
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Speaker 1: that you if you have insurance in the US, you
5:41
Speaker 1: have it through an employer. Yeah. Most people have insurance
5:45
Speaker 1: through their company and their employer UM. Not as many
5:48
Speaker 1: people have the more expensive and harder to get individual insurance. Yeah.
5:53
Speaker 1: I think fifty percent get it through the employer UM
5:56
Speaker 1: and thirty get it through the government run program Medicaid
6:00
Speaker 1: or Medicare, right. Medicaid Medicare were created in I think
6:04
Speaker 1: ninety five by the Johnson Administration j and UM. The
6:11
Speaker 1: s CHIP is the other big one for children, and
6:14
Speaker 1: that's state run like Medicaid. Medicare is for the elderly
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Speaker 1: and the chronically disabled, and peculiarly UM people with with
6:25
Speaker 1: kidney failure, renal failure. Yeah, Uh, Medicaid, as I said,
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Speaker 1: it's state run. UM is for other people with disabilities,
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Speaker 1: the poor you can't afford it, and pregnant women. And
6:38
Speaker 1: then s CHIP is for kids, yes, and that is
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Speaker 1: UH covers uninsured children under the age of nineteen whose
6:45
Speaker 1: families earned up to thirty six thousand, two hundred per year.
6:49
Speaker 1: Look at you with the stat I've got a lot
6:51
Speaker 1: of stats. I was gonna say, sinse that that's the
6:53
Speaker 1: first of many, right, and then actually there was one
6:55
Speaker 1: more that I don't know if you knew about the
6:57
Speaker 1: high risk health insurance pools. And these are people that
7:01
Speaker 1: have pre existing conditions that normally would not be able
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Speaker 1: to get insurance at all. And they what they do
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Speaker 1: is a group these people together, same concept as as
7:09
Speaker 1: an employee employee based deal. Those are the ones you
7:11
Speaker 1: see on little ninety nine cent signs. On the side
7:14
Speaker 1: of the road, like need insurance kind of thing, you
7:17
Speaker 1: just get lumped together. UM. So yeah, there's that. You
7:21
Speaker 1: just pointed out one UM type of insurance, which is
7:24
Speaker 1: group insurance. Most employer plans, probably all employer plans UM
7:30
Speaker 1: are group insurance. And it works because it is a
7:33
Speaker 1: group because you're and these are good because you usually
7:36
Speaker 1: don't have to fill out the big questionnaire about your
7:39
Speaker 1: eating habits and you're smoking habits and um, there's no
7:42
Speaker 1: physical exam exactly, and pretty much anybody who wants to
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Speaker 1: take part can contribute and be insured. Any employee, I
7:49
Speaker 1: should say, and usually their family kids, that kind of thing. UM.
7:53
Speaker 1: A very small portion of the US population has UM
7:58
Speaker 1: individual plans. And one of the reasons why is because
8:01
Speaker 1: you have to go through a rigorous screening process. It's
8:03
Speaker 1: not cheap. If you are found to have a pre
8:06
Speaker 1: existing condition, Um, you can be denied insurance very easily,
8:11
Speaker 1: I imagine, pretty heartbreaking. And yeah, it's it's really expensive.
8:15
Speaker 1: It's it's very it's an expensive UM proposition, UM, whether
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Speaker 1: you're an employer or an individual, and increasingly an employee. Right,
8:27
Speaker 1: So we'll get to that in a minute. What are
8:28
Speaker 1: some of the types of insurance plans that are out
8:31
Speaker 1: there in the US today, there's pretty much too umbrellas.
8:35
Speaker 1: Right as far as models go, I would say, so
8:37
Speaker 1: that I think you're talking about the f f S,
8:40
Speaker 1: the fee for service model, and then the managed care model,
8:43
Speaker 1: which so well you know which under the managed care
8:46
Speaker 1: is when you hear about HMOs and p P O
8:48
Speaker 1: s and pos and that those are all managed care. Yeah,
8:51
Speaker 1: the big the I guess the main characteristic of fee
8:56
Speaker 1: for service is and this is the original model for
9:00
Speaker 1: insurance indemnity insurance. You you, you pay your monthly premium
9:05
Speaker 1: and you're you're insured. You come down with the cold,
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Speaker 1: You go to the doctor, the doctor cures you. He
9:11
Speaker 1: gives you a coke and says, drink this and you'll
9:14
Speaker 1: be fine, right, and smoke the cigarette, right yeah yeah, um,
9:18
Speaker 1: And uh, you pay the doctor, you file some paperwork,
9:23
Speaker 1: your insurance company reimburses you, and you go along your merryway,
9:26
Speaker 1: continuing paying your monthly premiums. Again, right, this kind of
9:29
Speaker 1: old school model like what our grandparents probably hadn't right.
9:32
Speaker 1: And then I think in the eighties that hm mos
9:34
Speaker 1: came about, managed care became um much more popular than
9:39
Speaker 1: the FFS model, and actually there's some UM plans that
9:43
Speaker 1: kind of combined the two. But with managed care UM
9:47
Speaker 1: with fee for service, the the emphasis is on treatment.
9:51
Speaker 1: With managed care, there's more emphasis on prevention, supposedly, and
9:55
Speaker 1: that's where it really that's one of the big sticking
9:58
Speaker 1: points with this whole mess that we have in this
10:00
Speaker 1: country is a lot of doctors and a lot of
10:05
Speaker 1: managed care still don't practice enough preventative care, they say, right, So,
10:10
Speaker 1: at the center of the managed care model is a
10:13
Speaker 1: primary physician who's supposed to know you, know your family,
10:17
Speaker 1: know your history, know that you eat more donuts than
10:20
Speaker 1: you should, know that you lied on your insurance form
10:24
Speaker 1: when you said you don't smoke, and is saying you're
10:26
Speaker 1: gonna get the beats, you're gonna get lung cancer. Somebody
10:29
Speaker 1: who knows you, who you've seen, and who who can
10:32
Speaker 1: you you can trust to kind of guide and manage
10:36
Speaker 1: your health. Right, they're kind of a dying breed too, sadly, definitely,
10:39
Speaker 1: And um, there's a good reason why, Chuck, you read
10:42
Speaker 1: that CNN article that was distressing. Actually it was an
10:45
Speaker 1: editorial by Dr Vance Harris, I believe, and uh he
10:49
Speaker 1: basically gave a rundown of why the primary care physician
10:52
Speaker 1: is becoming a dinosaur, right, Yeah, it was pretty pretty
10:55
Speaker 1: depressing actually. So he was saying that for every several
10:58
Speaker 1: thousand dollars he saves the healthcare industry by using his
11:05
Speaker 1: medical training to actually make diagnosis rather than really expensive
11:09
Speaker 1: screenings like treatment as opposed to procedure. He said that
11:14
Speaker 1: for every several thousand dollars he saves the industry, he
11:17
Speaker 1: makes fifty bucks. Um, so he's there. It's a primary
11:23
Speaker 1: care physicians are not making a lot of money. What's more,
11:26
Speaker 1: there's a lot, uh, there's a lot of issues surrounding malpractice.
11:31
Speaker 1: On one hand, you can say, well, the very fact
11:34
Speaker 1: that there's malpractice losses out there, and they often add
11:37
Speaker 1: up to astronomical amounts of money being paid out to
11:41
Speaker 1: people who are found to have been the victim of malpractice.
11:45
Speaker 1: Doctors are a little nervous about relying on their medical
11:49
Speaker 1: training to make a diagnosis when there's an m R
11:51
Speaker 1: I machine in the next room that they can just
11:54
Speaker 1: say this is going to solve it one way or another.
11:56
Speaker 1: Although fo a fact. And then at the very least,
11:59
Speaker 1: even if I'm said, I could say, well, the m
12:01
Speaker 1: r I manufacturer screwed up. You know. Uh, there's a
12:04
Speaker 1: lot of passing the buck because of that, supposedly, but
12:07
Speaker 1: there's another way of looking at that correct well, medical malpractices.
12:12
Speaker 1: You hear a lot about UM doctor saying that's driving
12:14
Speaker 1: us out of business. We can't afford the premiums UM.
12:18
Speaker 1: We have too many patients. We haven't to squeeze in
12:20
Speaker 1: patients that that come in for you know, because they're worried.
12:25
Speaker 1: I know, cyberchondria feeds into it. People read on the internet,
12:28
Speaker 1: I've got reflux, I need to get a endoscopy, and
12:32
Speaker 1: they go in there and demand one, which I mean, really,
12:36
Speaker 1: it's it's there. It's your right. You're a patient and
12:38
Speaker 1: you want to make sure that you have a healthy body.
12:41
Speaker 1: It's tricky business, though, it is, because there what did
12:44
Speaker 1: you call it, cyberchondria? Yeah, excellent, it's uh an argument
12:48
Speaker 1: that's often used against pharmaceutical companies. Uh. Advertising on television,
12:55
Speaker 1: you get the impression that they are educating the consumer,
12:58
Speaker 1: just say hey, here's the words you use when you
13:00
Speaker 1: talk to your doctor and get our pill. You know,
13:03
Speaker 1: I mean, how how much of an effect has that
13:05
Speaker 1: had on UM over prescription. I'm sure a bunch and
13:11
Speaker 1: there's uh, there's so much information out there now, that's
13:14
Speaker 1: the first thing I do. I diagnose myself on the
13:16
Speaker 1: internet all the time, and I know a lot of people.
13:19
Speaker 1: Do you really Oh yeah, man, what's you What do
13:21
Speaker 1: you have? Like that? Reflux? Big time? You're not much
13:26
Speaker 1: of a complainer, Chuck, shut up, really had no idea
13:29
Speaker 1: you have reflex bad reflux, dude. Let's take it back
13:32
Speaker 1: to uh can when you talk about my practice again
13:35
Speaker 1: real quick, because I do have a study. UM, so
13:37
Speaker 1: you hear a lot about how how those costs are
13:39
Speaker 1: driving doctors out of business. And I'm not saying one
13:42
Speaker 1: way or the other. I'm just gonna throw the study out.
13:44
Speaker 1: The Americans for Insurance Reform they are a coalition made
13:48
Speaker 1: up of Consumer Federation of America, Consumer Watchdog dot organ
13:51
Speaker 1: a hundred other public interest groups. They release a study
13:55
Speaker 1: UM this week actually that found that malpractice premium are
14:00
Speaker 1: down and at the lowest they've been in thirty years.
14:03
Speaker 1: UM malpractice claims are down since two thousand and in
14:08
Speaker 1: states where the states have limited the consumer's ability to
14:13
Speaker 1: sue for malpractice, premiums are about the same as in
14:16
Speaker 1: other states. So I'm not saying they're not paying a
14:18
Speaker 1: lot and it's not putting a dent. But they do
14:21
Speaker 1: say that malpractice claims only constitute one fifth of one
14:26
Speaker 1: percent of annual healthcare costs in the United States, So
14:29
Speaker 1: that's kind of an obsolete argument these days. Well, it
14:32
Speaker 1: may be a little overblown. I mean, of course, tell
14:34
Speaker 1: the doctor that that has to pay a lot of money.
14:36
Speaker 1: But from what I read, it's it's not the central
14:40
Speaker 1: problem like some people say, like it needs reform, it
14:42
Speaker 1: needs to be controlled by the government who knows. Okay,
14:47
Speaker 1: I'm just here to report the facts, and you did
14:49
Speaker 1: an excellent job. Thanks. Let's go back to UM talking
14:53
Speaker 1: about where you get your insurance, right. We talked about
14:57
Speaker 1: employer based plans. We talked about people who who get
15:00
Speaker 1: the their insurance individually, right, people who get it from
15:04
Speaker 1: the state. UM. And then there's another group known as
15:07
Speaker 1: the uninsured. Yeah, and this is where it gets really hinky.
15:10
Speaker 1: The number of the uninsured is uh, kind of all
15:13
Speaker 1: over the map right now. Well, yeah, and also it's
15:15
Speaker 1: one of the central folk I of UM the insurance
15:19
Speaker 1: or healthcare reform debates. Well that there's forty five actually
15:24
Speaker 1: as far as August two thousand nine, UH Census Bureau
15:27
Speaker 1: figures forty five point six million uninsured Americans and that
15:31
Speaker 1: if you're a person who believes that healthcare is a
15:33
Speaker 1: human right, you think that these people should be covered
15:36
Speaker 1: in some form or fashion, right, right, And they're really
15:39
Speaker 1: nitpicking this number because this number, the number of uninsured,
15:44
Speaker 1: is largely what a lot of the financing is going
15:46
Speaker 1: to be based on. Yeah, we'll trying to project like
15:48
Speaker 1: a decade into the future. And if they don't get
15:51
Speaker 1: that number right, you know, the money doesn't work out,
15:53
Speaker 1: then that's when you're really screwed. Well sure, um, you
15:57
Speaker 1: were saying that not everybody's on the same page. Who
16:01
Speaker 1: the uninsured are? How many there are? Um, there's a
16:04
Speaker 1: guy named Michael D. Tanner of the Cato Institute, and
16:07
Speaker 1: he pointed out that actually, I'm more of a Brookings
16:12
Speaker 1: Institute Fann. Cato is pretty good to be all about Kato.
16:16
Speaker 1: I was, I've, I've, i've, I'm still am I, but
16:19
Speaker 1: I like Brookings these days. So Tanner's Tanner points out
16:23
Speaker 1: that UM about twelve million of the forty five point
16:27
Speaker 1: six million people who are uninsured in the US UM
16:31
Speaker 1: are eligible for Medicaid or s CHIP. They just haven't
16:34
Speaker 1: signed up. It's a really good point. He also points
16:38
Speaker 1: out that if they ever go in for treatment, that
16:41
Speaker 1: should pop up um in in whatever patient data that
16:46
Speaker 1: the administrator takes in, and they'll be automatically enrolled in
16:49
Speaker 1: whatever program suits them. Right, So that takes care of
16:53
Speaker 1: twelve million. One of the ones I don't necessarily agree with.
16:57
Speaker 1: And I think people who think that health care is
16:59
Speaker 1: a universal human and Wright would disagree with very much,
17:02
Speaker 1: as he points out that about ten million of these
17:05
Speaker 1: people who are uninsured in America aren't Americans. You're illegal.
17:09
Speaker 1: And you know, it depends on when you start looking
17:11
Speaker 1: at these numbers. I started looking around there, people are
17:13
Speaker 1: throwing all everybody's got a number. It's because it's hard
17:17
Speaker 1: to count and account for these people. Yeah, Uh, they're
17:20
Speaker 1: generally illegal. Immigrants aren't gonna step forward and say, you know,
17:23
Speaker 1: count me on your report. So that's one reason. But
17:26
Speaker 1: he Tanner also makes one last point that, um, you
17:29
Speaker 1: and I are kind of anomalies, Chuck and having gone
17:32
Speaker 1: several years without insurance when we were younger men. Uh,
17:35
Speaker 1: about fifty of the uninsured in the US go six
17:40
Speaker 1: months or less without insurance. So really, this forty five
17:43
Speaker 1: points six million Americans, even if the number remains the same,
17:47
Speaker 1: who makes up this population is changing constantly, right, it's
17:52
Speaker 1: a snapshot. Basically, I saw this one person put it
17:54
Speaker 1: in one of the articles you sent me, So yeah,
17:56
Speaker 1: exactly how many uninsured people there are and who they
17:59
Speaker 1: are is kind of a big part of this debate
18:01
Speaker 1: about whether you know health care needs reform. Actually, let
18:06
Speaker 1: me let me correct myself. I haven't run across anybody
18:09
Speaker 1: who says that healthcare doesn't need reforming. Of you. Now,
18:14
Speaker 1: everybody agrees that there's something wrong, that it's broken, and
18:17
Speaker 1: the World Health Organization would probably agree with well, hold on, first,
18:21
Speaker 1: let's talk about some of the different arguments. There's some
18:23
Speaker 1: people who say that public health care is nothing more
18:26
Speaker 1: than just uh, a weak part of the American welfare state.
18:31
Speaker 1: And why should my taxes pay for some other guys
18:35
Speaker 1: health insurance when I'm paying through the nose? Um. The
18:40
Speaker 1: you could say that competition might ease this this, you know, um,
18:46
Speaker 1: giving people vouchers to go buy their own insurance might
18:49
Speaker 1: make them a little more penny wise with how they
18:52
Speaker 1: spend their money. Um. Really, ultimately, what seems to be
18:58
Speaker 1: agreed upon by every buddy, is that the American healthcare
19:02
Speaker 1: system is too expensive for what it provides big time.
19:08
Speaker 1: So let's talk about if you mentioned the World Health Organization,
19:11
Speaker 1: this was huge and this this still the study was
19:14
Speaker 1: from two thousand and it remains a real um piece
19:19
Speaker 1: of ammunition that's used many different ways in the debate
19:24
Speaker 1: on healthcare reform. It was a groundbreaking study. And like
19:27
Speaker 1: you said, we are the most expensive. We spend more
19:29
Speaker 1: money on healthcare than anyone in the world. We spend
19:32
Speaker 1: sixteen In two eight, we spent sixteen point six percent
19:35
Speaker 1: of our GDP on healthcare, not just government spending, but
19:38
Speaker 1: just across the board GEZ sixteen point six of the
19:42
Speaker 1: market sixteen point six percent of the market value of
19:44
Speaker 1: the United States, and that that year was spent just
19:48
Speaker 1: on healthcare. That's more than defense. Buddy. We were in
19:52
Speaker 1: Iraq and Afghanistan at that time. If you, if you
19:55
Speaker 1: give me a number like that, I would say in response, Josh,
19:59
Speaker 1: that of the during ninety one countries, say study, then
20:01
Speaker 1: that probably means that we're at the top of the list.
20:03
Speaker 1: Then for what you get for your dollar, you would
20:05
Speaker 1: think we should be since we have the most expensive
20:07
Speaker 1: and technologically sophisticated healthcare system in the world, top ten
20:14
Speaker 1: to one. You would think, oh, where we should be? Yeah,
20:18
Speaker 1: I mean I don't easy, yeah, but I'm gonna give
20:21
Speaker 1: you some leeway and say, top ten. Okay, how what
20:24
Speaker 1: is it really? Seven in the world out of a
20:28
Speaker 1: d countries? You know who is just above us? Costa Rica? Awesome?
20:33
Speaker 1: You know who's just below us? Slovenia. Wow, Yeah, that's
20:38
Speaker 1: where the US ranks against Slovenia. But yeah, since we
20:45
Speaker 1: have the most expensive health care system in the entire
20:48
Speaker 1: world on the planet, we should by proxy have the
20:53
Speaker 1: best health care system is rated by the World Health Organization.
20:57
Speaker 1: You want to hear something else, chilling? Uh, Americans life
21:01
Speaker 1: expectancy is lower than Canada, half of the Caribbean, including
21:05
Speaker 1: Puerto Rico, in Cuba, Chile, all of Western Europe, some
21:10
Speaker 1: of Eastern Europe, Israel, Jordan's, Singapore, Hong Kong, Japan, Australia,
21:14
Speaker 1: and New Zealand are life expectancy is lower than all
21:17
Speaker 1: of those countries. And I'm not necessarily saying that definitely
21:20
Speaker 1: means that their health care system is so much better,
21:23
Speaker 1: but it probably lends itself to to that argument. I
21:27
Speaker 1: know the study you're referring or the article you're referring to,
21:30
Speaker 1: Chuck and um. It references a study from the New
21:33
Speaker 1: England Journal of Medicine from about ten years ago that
21:36
Speaker 1: showed that the average black man in Harlem was less
21:39
Speaker 1: likely to reach age sixty five than a man in Bangladesh.
21:44
Speaker 1: That is messed up. That's not supposed to be. No, no,
21:47
Speaker 1: not when you're spending the kind and we're not saying
21:49
Speaker 1: because America is so much better. It's because we spend
21:51
Speaker 1: the kind of money we spend in respect better results.
21:54
Speaker 1: That's one thing that a lot of people have agreed
21:56
Speaker 1: up on the um. The other point to this is
22:00
Speaker 1: by the way we spent two point four trillion dollars
22:02
Speaker 1: in two eight on healthcare. Right, healthcare spending and costs
22:07
Speaker 1: continue to increase, but as someone else pointed out in
22:13
Speaker 1: are mortality rate flattened, it hasn't gotten better since then. So,
22:17
Speaker 1: in short, the US is not getting enough bang for
22:20
Speaker 1: its buck as far as it's health care system. We're
22:23
Speaker 1: not getting healthier, but we're certainly spending more money. What's
22:26
Speaker 1: going on, Well, I mean, there's a Jesus there's a
22:29
Speaker 1: lot of reasons. I know. One thing a lot of
22:31
Speaker 1: people point at is the aging baby Boomerson out the
22:34
Speaker 1: age where they need a lot of care in the
22:35
Speaker 1: hospitals and buy doctors. Uh, there are fewer and fewer
22:38
Speaker 1: doctors and nurses, so uh, they're not getting as good
22:42
Speaker 1: at care. And there's more. Um. I think they just
22:45
Speaker 1: called the medical errors in the article I read because
22:47
Speaker 1: of understaffing. That's one reason you're what you're talking about
22:52
Speaker 1: could actually be considered symptoms. And we should probably say,
22:56
Speaker 1: just for c o A, that if you what Jerry
23:00
Speaker 1: and Matt in here, you would get a totally different
23:04
Speaker 1: podcast with all the same research. There are so many
23:09
Speaker 1: ways of looking at this issue that all you and
23:12
Speaker 1: I can do here, Chuck is try to get to
23:15
Speaker 1: the central focus of it without you know, leaning into
23:19
Speaker 1: partisan politics or anything like that. It seems to me
23:23
Speaker 1: from what I saw come up time and time again
23:25
Speaker 1: from UH sources on both the left and the right,
23:29
Speaker 1: pro business, pro labor, is that the American health care
23:34
Speaker 1: system is too sophisticated, it's too advanced, and patients have
23:40
Speaker 1: too much access to it, too much, you could say,
23:43
Speaker 1: frivolous access to it. So that m R I scam.
23:46
Speaker 1: We were talking about demand, right, the patient demands it
23:51
Speaker 1: because that money that goes towards your employer based insurance
23:57
Speaker 1: policy comes out of your paycheck, right and when when
24:02
Speaker 1: so right there, this is money you haven't even seen
24:04
Speaker 1: it comes out before hit your your paychecks direct deposited
24:07
Speaker 1: into your account. Right. Secondly, it's relatively cheap, and when
24:12
Speaker 1: you go to the doctor, you're not actually shelling out
24:14
Speaker 1: money nor so you have no real incentive to be
24:20
Speaker 1: um cheap. What was the Simpsons huh episode you're talking about?
24:24
Speaker 1: So you remember? Do you remember the one where the
24:27
Speaker 1: home Homer and Lisa go into isolation tanks um, which,
24:32
Speaker 1: by the way, I did recently and it was cool. Um.
24:35
Speaker 1: And Homer's isolation tank is repossessed while he's in there,
24:39
Speaker 1: and one of the laborers who's repossessing this thing tells
24:43
Speaker 1: the other one to lift with his knees, and the
24:45
Speaker 1: other guy goes, screw it. I've got health insurance, right,
24:47
Speaker 1: And that's kind of the attitude some people take is
24:49
Speaker 1: I'm paying for this, I'm gonna get my money's worth
24:51
Speaker 1: out of it, exactly. So I got some heartburn, I'm
24:53
Speaker 1: gonna go demand the camera down the throat instead of
24:57
Speaker 1: trying to treat it and see if or not eat
24:59
Speaker 1: chocolate and read right. Well, that that's the other thing
25:01
Speaker 1: that it portrays is that we aren't taking responsibility for
25:05
Speaker 1: our own health as Americans. We don't. And that's where
25:08
Speaker 1: it has a start, buddy, definitely, And part of that
25:12
Speaker 1: is putting that focus back on prevention again rather than treatment.
25:17
Speaker 1: Because consider this, if you have a an advanced disease,
25:22
Speaker 1: how much more rigorous is your treatment going to be?
25:25
Speaker 1: How many more doctors business does that entail? How many
25:28
Speaker 1: more UM scans does that, m R I scans does
25:31
Speaker 1: that entail? How much more for medication? And don't get
25:35
Speaker 1: me started in the pharmaceutical companies. Yeah, that's a different podcast.
25:38
Speaker 1: Um how much more UM time and effort and just
25:44
Speaker 1: cost is it going to take to treat an advanced
25:46
Speaker 1: stage disease? Then it's going to be to prevent it
25:49
Speaker 1: or treat it early on exactly. So like when they
25:52
Speaker 1: recommend it, I think forty or so for women to
25:55
Speaker 1: start getting your mamogram and for men to get the
25:58
Speaker 1: old how's your father treatment from your doctor? Yeah, these
26:03
Speaker 1: kind of things. People people avoid this stuff and then
26:05
Speaker 1: all of a sudden, you have, like you said, holy cow,
26:08
Speaker 1: got a tumor that's in an advanced stage because I
26:10
Speaker 1: haven't taken care of myself and I haven't done the
26:13
Speaker 1: regular checkups like I need to. And uh, it cost
26:17
Speaker 1: a lot more so this infrastructure that we're talking about,
26:21
Speaker 1: the health system infrastructure, it keeps growing and growing. Uh.
26:25
Speaker 1: It costs a lot to manufacture an m R I machine,
26:27
Speaker 1: and I keep I keep using that. But it's just
26:29
Speaker 1: such an easy example. Yeah. Um. And as a result
26:34
Speaker 1: of just not just the m R I machine, but
26:36
Speaker 1: all of these different external factors and possibly corporate greed um,
26:41
Speaker 1: from two thousand four to two thousand nine, the average
26:44
Speaker 1: cost on healthcare premiums increased four times faster than the
26:49
Speaker 1: average wage in the US. So, all of a sudden,
26:52
Speaker 1: healthcare is just getting more and more and more expensive,
26:55
Speaker 1: and not just for you and me, chuck, um, we
26:58
Speaker 1: are premium From into two thousand nine, are the employee
27:02
Speaker 1: contribution went from an average of fundred and forty three
27:05
Speaker 1: dollars to three thousand, three hundred and fifty four dollars.
27:09
Speaker 1: That's just our contribution. This isn't including employers contributions, which
27:14
Speaker 1: is affecting their bottom line, and as healthcare costs rise,
27:18
Speaker 1: they're losing a competitive edge in the global market in
27:22
Speaker 1: an increasingly globalized world, and all businesses have budgets. They
27:25
Speaker 1: work on budgets that also might affect the rays you
27:28
Speaker 1: might or might not get because of the budget and
27:31
Speaker 1: how much they're having to spend. I know, my father
27:34
Speaker 1: in law has a small business and did he has
27:37
Speaker 1: a really small business, like he only has a handful
27:39
Speaker 1: of employees, but he has a health insurance program. And
27:42
Speaker 1: one of the ladies that works with him is one
27:44
Speaker 1: of these people that does not take care of herself.
27:46
Speaker 1: She has like three or four surgeries a year and
27:50
Speaker 1: it's driving him out of business. Dude, this one lady. Yeah,
27:53
Speaker 1: and let me tell you something else, but buddy, the
27:56
Speaker 1: World Health Organization estimates that between nineteen and of the
27:59
Speaker 1: to dollars spent on healthcare here spent on administrative costs.
28:04
Speaker 1: Administrative costs. And another reason that it's so expensive is, uh,
28:08
Speaker 1: there's been a big shift I don't know if you've
28:10
Speaker 1: noticed in for profit hospitals as opposed to the old
28:14
Speaker 1: nonprofit model, the community model, and that's kind of helped
28:17
Speaker 1: drive up prices too. So they say, well, sure, not
28:19
Speaker 1: only that, but the uninsured drive up prices. Um, the
28:24
Speaker 1: the Medicaid Medicare are notoriously terrible. I'm paying out billing
28:30
Speaker 1: to physicians. Hospitals have started to use something called balanced building,
28:34
Speaker 1: where they um start building patients for procedures they didn't
28:39
Speaker 1: know they weren't covered for, and the insurance companies refusing
28:42
Speaker 1: to pay, and all of a sudden, you've got a
28:43
Speaker 1: collection agent all over you because the hospital didn't say, oh,
28:46
Speaker 1: by the way, this doctor right here, who you're you're
28:49
Speaker 1: about to see is out of your network, so you're
28:51
Speaker 1: gonna have to pay for him out of pocket. There's
28:54
Speaker 1: just there's we have big problems here, kidding, So Chuck,
29:00
Speaker 1: how do we solve this? I have no idea. Other
29:04
Speaker 1: people to thank heavens for that. Well, one of those
29:06
Speaker 1: people is a man named Mr Barack Obama. You may
29:10
Speaker 1: know him as President Obama. He's got a plan for
29:13
Speaker 1: healthcare reform, and we're gonna cover that in the next
29:16
Speaker 1: installment of the podcast, Barack Obama's Healthcare Reform Plans Soup
29:20
Speaker 1: to nut. But again, this is kind of a weighty
29:24
Speaker 1: topic and we're gonna need some help. So we're gonna
29:27
Speaker 1: recruit Molly Edmonds, right, Molly Edmunds of Stuff Mom Never
29:31
Speaker 1: Told You, popular sister podcast and all our our healthcare writer. Well, yeah,
29:36
Speaker 1: she's been completely submerged in healthcare for the last three weeks,
29:39
Speaker 1: health in general. She's our health writer, she is, but
29:42
Speaker 1: she's been studiously studying healthcare reforms. So she's gonna come
29:46
Speaker 1: in for the next few uh podcasts to help us
29:49
Speaker 1: sort through things. We can rely on her a little bit.
29:52
Speaker 1: And we also spoke to Dr Michael Royson, who is
29:55
Speaker 1: the chief Wellness Officer of the Cleveland Clinic and more
29:59
Speaker 1: famously known as co author of the You the Owner's
30:02
Speaker 1: Manual series of books. With Dr got him on the phone. Yeah,
30:06
Speaker 1: he was awesome. So it's gonna be like a whiz bang,
30:08
Speaker 1: super big healthcare reform podcast and hopefully by the end
30:11
Speaker 1: you will know as much as Molly Edmonds, which is substantial.
30:16
Speaker 1: So stay tuned for the second episode, which will be
30:18
Speaker 1: out in a week. And in the meanwhile, you can
30:20
Speaker 1: go to how Stuff works dot com, type in healthcare
30:24
Speaker 1: in our handy search bar and you're going to find
30:27
Speaker 1: a slew of really thoroughly researched and well written articles
30:31
Speaker 1: by Molly Edmonds, and if you want to send us
30:34
Speaker 1: an email about healthcare or anything else, you can shoot
30:37
Speaker 1: that to stuff podcast at how stuff works dot com.
30:41
Speaker 1: Perfect for more on this and thousands of other topics.
30:48
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30:51
Speaker 1: stuff works, check out our blogs on the house. Stuff
30:54
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