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Rumors, Myths and Truths Behind Obama's Health Care Plan · Stuff You Should Know

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Speaker 1: Brought to you by the reinvented two thousand twelve Camray.
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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: Charles W. Bryant and with Charles W. Bryant, and I
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Speaker 1: is our colleague and healthcare reform guru Molly Edmonds. I
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Speaker 1: think it would be and me. She was gonna say that, Yeah,
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Speaker 1: saw that coming. Yeah, well he's not the first person
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Speaker 1: to do that, Moll. You can send an email to
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Speaker 1: Stuff podcast dot com. You shouldn't an email, Molly. Thank you.
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Speaker 1: I'm here to keep you on track on all things
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Speaker 1: grammatical and healthcare format anything else. Yeah, that's good. That's
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Speaker 1: that's enough, right, perfect. So for those of you just
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Speaker 1: joining us, you should probably go back and listen to
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Speaker 1: the first two podcasts that we released in this special
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Speaker 1: Stuff you Should Know Healthcare Reform Sweet and this is
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Speaker 1: number three of four or Yes, we talked about what's
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Speaker 1: wrong with healthcare in the US, and the first one, right,
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Speaker 1: we talked about Obama's proposal just straight up facts, and
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Speaker 1: then this this one we're gonna talk about myths yes,
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Speaker 1: both from the left and the right. So you know,
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Speaker 1: those of you who are Bill O'Reilly fans, you can
1:18
Speaker 1: sit down and have a mug of beer with people
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Speaker 1: who are fans of MPR. Say right, if you're libertarian,
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Speaker 1: you're just sorry you're out. Just go go do whatever
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Speaker 1: it is you guys do a nice chuck um, So
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Speaker 1: let's get started, kids, you wanna. I think one of
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Speaker 1: the things that that people keep maybe weekly throwing out
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Speaker 1: is that the US can't really afford to tackle healthcare
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Speaker 1: form right now? Is that that's a myth? Are we
1:45
Speaker 1: doing that? Should we have some sort of ding said
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Speaker 1: it's a myth? And I agree with her. Well, you know,
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Speaker 1: the thing about it is is would you you may
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Speaker 1: not be able to afford like a new TV, right,
1:56
Speaker 1: but if you had an old TV and it was
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Speaker 1: a tremendously bad value you I mean, if you're just
2:01
Speaker 1: paying way more for that TV than what it's worth
2:03
Speaker 1: to get it repaired a lot and not gonna yeah,
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Speaker 1: I mean, then you've got to do something about it
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Speaker 1: because you're just you're not getting a good deal on
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Speaker 1: your TV. Sometimes it's smarter to buy the new TV. Yeah,
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Speaker 1: And that is the position we are in right now
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Speaker 1: with health care form, is we pay way too much
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Speaker 1: money and get way too little care for for what
2:17
Speaker 1: we have. So just if you like a good deal,
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Speaker 1: I think you should be behind health care form. So
2:22
Speaker 1: let's let's recap real quick. Um, the US is spending
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Speaker 1: about two point four trillion dollars a year on healthcare.
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Speaker 1: That makes up a sixth of the gross domestic product,
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Speaker 1: and that's more than we spend on defense. Right. Um.
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Speaker 1: At the same time, we're not getting as much value
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Speaker 1: out of it. So they say, right, but we are
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Speaker 1: entrenched in two wars and the economies in the toilet.
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Speaker 1: You're saying, still, we should do something about it. Now,
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Speaker 1: how are we going to pay for it? That's another
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Speaker 1: that's another common criticism we keep hearing is how how
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Speaker 1: are we going to pay for this? Well, I think
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Speaker 1: the specifics stilling to be worked out, but I think
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Speaker 1: that it's important to remember that the president it has
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Speaker 1: pledged that will be deficit neutral. It's not going to
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Speaker 1: add appending to the deficit in the ten years, the
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Speaker 1: first ten years that it is in action, nor after that. So, um,
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Speaker 1: you know, it's it's something that we could possibly say
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Speaker 1: as a myth just because we don't know exactly how
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Speaker 1: I'll pay for it. But one thing I take them
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Speaker 1: with a grain of salt. Yeah, I liked your point
3:18
Speaker 1: you made in here that the people are afraid that
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Speaker 1: the uninsured are going I'm sorry, the insured are going
3:22
Speaker 1: to be paying for the uninsured. That already happens. Oh yeah,
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Speaker 1: I mean, there's an estimate that families are paying about
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Speaker 1: a thousand more in their premiums just because people who
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Speaker 1: are uninsured still show up and go to the hospital
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Speaker 1: and they get treated, and an individual pays about four more.
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Speaker 1: And so doctors and hospitals likely ship those costs to
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Speaker 1: us because I mean, they got to get paid for
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Speaker 1: it somehow, and they know insurance companies will pay. So
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Speaker 1: let's let's let's flesh that out a little more. Say
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Speaker 1: an uninsured worker day labor gets hurt on the job,
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Speaker 1: the boss comes and drops them off at the er.
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Speaker 1: The r BI federal mandate has to treat that man,
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Speaker 1: stabilize them, fix his wound whatever. Right, Um, he walks away,
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Speaker 1: he doesn't pay, he doesn't have any insurance and possibilities
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Speaker 1: here illegally say. Um, so what you're saying is the
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Speaker 1: hospitals will end up charging more for patients that have insurance.
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Speaker 1: They'll charge the insurance companies more, and then the insurance
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Speaker 1: companies turn around and charge more for people who have insurance.
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Speaker 1: They they charge more in premiums. Right, And then that's
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Speaker 1: the way that there's a tax, UH, an invisible tax
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Speaker 1: for the uninsured that covers the uninsured that's in place
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Speaker 1: right now. Right. That's that's the thinking by UM, the
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Speaker 1: think tank that came up with these numbers, that we
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Speaker 1: are already paying for people who show up without insurance.
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Speaker 1: And so if these people then had insurance, if this
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Speaker 1: plan works and we can get everyone insured, then that
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Speaker 1: would kind of cease that we're hoping that it would
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Speaker 1: control the costs a little bit. Yeah, that would be great.
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Speaker 1: So this is a one trillion dollar proposal over ten years, right,
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Speaker 1: So clearly just UM making sure everyone has insurance in
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Speaker 1: and of itself is going to be very expensive, right. UM.
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Speaker 1: Is it a myth then that there won't be higher
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Speaker 1: taxes for people who who, say, make a quarter of
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Speaker 1: a million dollars or more a year. I think that
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Speaker 1: it's impossible to say what we'll actually have in place,
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Speaker 1: but that is the president's current preferences that we tax
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Speaker 1: people who make more than two dollars a year. Okay,
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Speaker 1: and then I noticed the point that, um, that the
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Speaker 1: President and people like Nancy Pelosi have made is that
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Speaker 1: those people had been getting a lot of breaks over
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Speaker 1: the previous eight years, and so they think that this
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Speaker 1: is going to sort of balance that outout without getting
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Speaker 1: too political about it. But that's what's being said. True,
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Speaker 1: Chuck can't help himself. That's gonna started about libertarians. Nancy
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Speaker 1: Pelosi said, not me. So, Um, guys, this light in
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Speaker 1: the mood a little bit. Let's talk about death panels.
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Speaker 1: Let's bring a little comedy into this one. This is
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Speaker 1: probably the most pervasive myth I would say about healthcare form,
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Speaker 1: and arguably the most ass And I wouldn't you say,
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Speaker 1: I don't know. I think if you are told that
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Speaker 1: you might be put to death, you're gonna take it
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Speaker 1: pretty seriously. Yeah, you will take it seriously. But I'm
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Speaker 1: saying the I guess the the thought process behind that
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Speaker 1: interpretation of UM. The House Bill about end of life counseling,
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Speaker 1: that's what it's about, right, So basically in the House Bill,
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Speaker 1: it says UM medicaid or medicare can be reimbursed for
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Speaker 1: voluntary end of life counseling. Right. It doesn't say anything
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Speaker 1: about the patient signing signing a resuscitation order or do
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Speaker 1: not resuscitate order um or any any anything like that
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Speaker 1: has nothing to do with actually terminating a patient's life. Right.
6:35
Speaker 1: It's like they would stick the pin in Grandma's hand
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Speaker 1: and like put it on the line, and if she
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Speaker 1: just falls asleep and it scratches across, then all of
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Speaker 1: a sudden there's a do not resuscitate order in the
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Speaker 1: one less old person we have to worry about getting
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Speaker 1: an organ transplant for because she voluntarily said I don't
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Speaker 1: want it. It It is a myth. And not only is
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Speaker 1: it a myth, uh, it is a career ruiner too
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Speaker 1: if you speak out too much. You guys heard about
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Speaker 1: Betsy McCoy, John Stewart, Is that the lady? He? Yeah?
7:04
Speaker 1: Have you seen that, Molly? Yes, it's pretty someone that
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Speaker 1: came up with the term death panel? Right? Yeah? Am
7:09
Speaker 1: I wrong there? I believe she's just the one. She
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Speaker 1: didn't coin it. She gets credit for coining if she
7:13
Speaker 1: was so vociferous about it. Right, So you know what,
7:17
Speaker 1: here's the thing without pointing fingers at who came up
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Speaker 1: with it. No one wants to die, right, I would
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Speaker 1: say most people people don't want to die, and they
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Speaker 1: also probably don't want to spend a lot of time
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Speaker 1: thinking about how they're going to die, right, And so
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Speaker 1: the fact that we're even bringing this conversation up just
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Speaker 1: makes it uncomfortable for some people. The fact of the
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Speaker 1: matter is is that we probably all have in our
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Speaker 1: head that we'd like to die, maybe peacefully, at home.
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Speaker 1: And the fact of the matter is now most people
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Speaker 1: die in a hospital or a nursing facility. Whereas would
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Speaker 1: prefer not to die, there are dying there. So what
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Speaker 1: we're trying to do is to respect well, not I
7:54
Speaker 1: shouldn't say we like it's not me trying to do this,
7:56
Speaker 1: but what these bills are trying to do is to
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Speaker 1: make sure that if you do have a wish about
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Speaker 1: how you die or who makes the decisions at that
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Speaker 1: time when you maybe can't speak for yourself, that those
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Speaker 1: wishes are respected. The a ARP has come out and
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Speaker 1: support of this because the fact of the matter is
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Speaker 1: is that even if we don't like to talk about it,
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Speaker 1: it's going to happen. Let's have the conversation and if
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Speaker 1: you have the conversation, have it paid for by Medicaid
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Speaker 1: and medicare, right, But you don't have to have the
8:20
Speaker 1: conversation if you don't want to. It's completely voluntary. And
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Speaker 1: even if you have it, you're not going to leave
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Speaker 1: that meeting with a living will necessarily or um you know,
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Speaker 1: a d n R order. You're gonna leave just knowing
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Speaker 1: what your options are. But I wasn't gonna put my
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Speaker 1: opinion in, but that sounds like a really good idea
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Speaker 1: to me. Sure it is. And also um Stewart pointed
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Speaker 1: out on in the interview that you can just as
8:40
Speaker 1: easily come out of it with a resuscitate at any
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Speaker 1: cost order. So it's it's not just specifically about DNA.
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Speaker 1: Why they call it death panel. They should have called
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Speaker 1: it life no matter what. Because the death panel scares
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Speaker 1: the tara elder, right, That's I think that was the
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Speaker 1: most one of the most odious things that come out
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Speaker 1: of this healthcare form debate was the panel. I mean,
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Speaker 1: it was just it was specifically geared to scare the elderly,
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Speaker 1: but you know, they already have enough things to worry about.
9:06
Speaker 1: I mean, I think that some of the elderly spears
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Speaker 1: about this bill are founded when you hear there's going
9:12
Speaker 1: to be cuts to Medicare and that there might be
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Speaker 1: incidences of euthanasia, which this is not true. The death
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Speaker 1: panel thing not true. But there will be cuts to Medicare.
9:20
Speaker 1: You can't get around that. Sure, let's talk about that,
9:22
Speaker 1: because that's a that's that's something that you raised in
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Speaker 1: this m article. That it won't affect Medicare is a
9:29
Speaker 1: is a is a myth, right, it's a promise that
9:32
Speaker 1: the President has made in terms of benefits that if
9:35
Speaker 1: you are a Medicare recipient, that you will still have
9:37
Speaker 1: the same benefits that you've always had. The fact of
9:40
Speaker 1: the matter is a large part of the funding for
9:42
Speaker 1: these proposals will likely come from Medicare because the way
9:45
Speaker 1: that Medicare operates now is probably unsustainable. So by making
9:50
Speaker 1: these cuts and incentivizing doctors to be more efficient in
9:54
Speaker 1: the way they treat patients, when we're talking about bundling services,
9:57
Speaker 1: bundling service, so actually we chuck and I spoke to
10:01
Speaker 1: Dr Michael Roisen, who's the chief wellness officer at the
10:04
Speaker 1: Cleveland Clinic in appropriately enough Cleveland, Ohio, uh and he's
10:09
Speaker 1: also co author of the You the Owner's Manual book series.
10:12
Speaker 1: And uh, he talked about bundling services. Uh. And it's
10:16
Speaker 1: based around what's called accountable organizations. It's like a group
10:21
Speaker 1: that's in charge of the health of an individual patient. Right.
10:24
Speaker 1: Here's here's what he had to say about that. So
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Speaker 1: I like accountable organizations, meaning that I that someone pays
10:32
Speaker 1: if you will, I, whether it's myself or um, the
10:35
Speaker 1: Cleveland clinic where I work, pays for my healthcare and
10:38
Speaker 1: I don't have to worry about it. And they get
10:41
Speaker 1: a set amount of money whether I need um, sixteen
10:45
Speaker 1: tooth extractions and four um if you will, revisions or
10:51
Speaker 1: four total hips to total hips, two total knees, or
10:55
Speaker 1: whether I need none. And the goal of them, of
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Speaker 1: those organizations would be then to keep me healthy so
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Speaker 1: that I don't need any major technology procedures. Teach me
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Speaker 1: how to brush my teeth in flash so I need
11:09
Speaker 1: no teeth extractions. Right. So that's what that's what I
11:12
Speaker 1: mean by pay for accountable outcomes. So if you couldn't tell,
11:17
Speaker 1: Dr Royson's very hip on prevention rather than preventative care, right. Um.
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Speaker 1: And and he's he's also on board with accountable organizations.
11:26
Speaker 1: And he's also evidently on board with tooth extraction. He is,
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Speaker 1: it's a good example. It's well, I mean, anybody can
11:32
Speaker 1: approach a tooth extraction, right, But the point is is
11:37
Speaker 1: there there has to be a group that is in
11:39
Speaker 1: charge of the health care of the individual, right, and
11:42
Speaker 1: then that way you can hold that group accountable. You're
11:45
Speaker 1: paying that group and you say, keep this person well,
11:48
Speaker 1: and if they do need treatment, this is your pool
11:50
Speaker 1: of money that you have to extract from it, right,
11:52
Speaker 1: like so many teeth. Now, here's the problem. And this
11:55
Speaker 1: is where I think a lot of the fear comes about.
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Speaker 1: Is what happens when that money runs out? Can doctors
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Speaker 1: be trusted to say we're going to still keep treating
12:03
Speaker 1: you or are they going to try to skinch on that?
12:07
Speaker 1: And I mean, is that a real fear? I think
12:10
Speaker 1: it's valid. You know, we would like to think that
12:12
Speaker 1: doctors become much more efficient. There's evidence that there is
12:15
Speaker 1: a lot of waste in the medicare system. And ideally
12:18
Speaker 1: how this will work as doctors will say, yes, we
12:20
Speaker 1: will become more efficient with this pool of money we have.
12:23
Speaker 1: But you know, you just never know what case is
12:25
Speaker 1: going to come up. That you can't treat a person
12:27
Speaker 1: with that pool of money with So Molly, you just
12:30
Speaker 1: brought up Another point is um rationing healthcare? Right? Um,
12:36
Speaker 1: that's another huge fear among you know, not just the elderly,
12:40
Speaker 1: but anybody like if if this bundling of payments goes
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Speaker 1: beyond just Medicare and it becomes a standard. UM, I
12:48
Speaker 1: guess one of the ways it would become a standard
12:50
Speaker 1: would be to have some sort of panel that approves
12:53
Speaker 1: medical procedures, right right, and UM, there are some panels
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Speaker 1: in these bills, but they do not approve medical procedures.
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Speaker 1: Let's talk about those. These UM cost effectiveness panels UM
13:04
Speaker 1: are just meant to come in and decide which treatments
13:07
Speaker 1: are effective. There's no evidence that they would come in
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Speaker 1: and say you can only do this because it's cheap. UM,
13:13
Speaker 1: it might be helpful to compare really quickly how Britain
13:16
Speaker 1: rations healthcare. Let's do it. Okay, So they've got this
13:18
Speaker 1: committee called UM ironically enough nice that stands for National
13:23
Speaker 1: Institute of Health and Clinical Excellence. And then they're under
13:26
Speaker 1: the NHS, which is their big public system. So let's
13:29
Speaker 1: say that, UM, there's a drug that costs fifteen thousand dollars,
13:34
Speaker 1: and it's going to improve your standard of life from
13:36
Speaker 1: a point five to a point seven. They look at
13:38
Speaker 1: everyone's standards of life from a zero to a one um,
13:42
Speaker 1: and it's worth saying that everyone's uh quality of life
13:45
Speaker 1: is considered important, whether you're seventy seven year old woman
13:48
Speaker 1: or a twelve year old boy. So it's gonna improve
13:51
Speaker 1: your standard of life from point five to point seven
13:54
Speaker 1: point two, and it's gonna help you live fifteen years longer. Okay,
13:58
Speaker 1: that's been proven in a study. So point two times
14:01
Speaker 1: fifteen is three. So they get a multiplayer and then
14:04
Speaker 1: so that's three. That's what they call three qualities quality
14:07
Speaker 1: adjusted life here, so they're saying you're quality of life
14:11
Speaker 1: has been adjusted for these three years. It's like a multiplayer.
14:15
Speaker 1: So then they're gonna divide the total cost of the drug,
14:17
Speaker 1: buy the multiplier and get a cost per year amount.
14:21
Speaker 1: In this case, if the drug is fifteen thousand dollars
14:23
Speaker 1: and your quality is three, the drug costs five thousand
14:26
Speaker 1: dollars a year, and that's the number on which the
14:30
Speaker 1: NICE would approve or not approve the drug. And NICE
14:33
Speaker 1: basically approves anything, basically anything that's about forty five thousand
14:37
Speaker 1: a year or below. So it's going to our system
14:42
Speaker 1: on that. No, that that's not in the bill. You know,
14:44
Speaker 1: when people talk about rational healthcare, Britain says, yes, we
14:46
Speaker 1: have rational healthcare and that's how they do it. And
14:48
Speaker 1: there's nothing like that in any of these proposals. Let's
14:52
Speaker 1: talk some more about um. Actually, before we do that,
14:54
Speaker 1: I want to bring up another point that that worries me,
14:57
Speaker 1: and that is um that these these panels that approve
15:02
Speaker 1: medical procedures could lead to a stifling of innovation. Right,
15:07
Speaker 1: is that a possibility? Well? I don't think so because
15:10
Speaker 1: if you look, I mean, even if you talk about Britain,
15:12
Speaker 1: it's not like Britain's way behind us on medical innovation.
15:15
Speaker 1: It's in some countries they've been able to do a
15:17
Speaker 1: lot more with a lot less. So isn't that sort
15:20
Speaker 1: of the true definition of innovation? So I think you
15:23
Speaker 1: basically have to prove that it works. I mean, we
15:25
Speaker 1: may not allow people to say this pill will take
15:28
Speaker 1: you to Mars if it won't. But um, what if
15:31
Speaker 1: they said this pill is dynamite? Do they mean dynamite
15:35
Speaker 1: like explosive or just dynamite like awesome, awesome, Okay, I
15:39
Speaker 1: mean they definitely would to prove something that was explosive
15:41
Speaker 1: in my opinion, Um, but I'm no doctor than the Yeah.
15:48
Speaker 1: Um so I think it's just um, you know, making
15:51
Speaker 1: people prove the quality. One of the problems uh so
15:54
Speaker 1: far is that we have a lot of care that
15:56
Speaker 1: we don't necessarily know if it works, but it's really expensive.
16:00
Speaker 1: And this is just ensuring that people have to prove
16:02
Speaker 1: that it works. And instead of spending all this money
16:04
Speaker 1: on marketing their drugs, drug companies might have to spend
16:07
Speaker 1: more money on research and development, which I think we
16:10
Speaker 1: can argue would benefit a patient more than marketing. Sure. Boy,
16:14
Speaker 1: last time I was in the doctor, the pharmaceutical people
16:17
Speaker 1: came came through there. Have you ever been to the
16:18
Speaker 1: doctor on the They walk in and go, we got
16:20
Speaker 1: some dynamite pills. No, well, who knows what happened behind
16:23
Speaker 1: the doors. But they were literally like seven of them.
16:25
Speaker 1: They were spaced out like every five or ten minutes.
16:27
Speaker 1: And they came walking in with their their suitcase that
16:30
Speaker 1: you know, it's just full of drugs, and they went
16:32
Speaker 1: in the back and then they came out, and then
16:33
Speaker 1: the next dude would go in sure, and then the
16:34
Speaker 1: doctor finally comes out after the last one leaves and
16:37
Speaker 1: his little uh, a little reflector was all skewed. He's like, next,
16:41
Speaker 1: Doctor feel Good. Yeah, So is that how it goes down?
16:44
Speaker 1: All these at a myth or truth? You know, I'm
16:46
Speaker 1: not I don't want to comment on doctor feel Good's
16:48
Speaker 1: personal life. Yeah, And we can't get into farming too
16:51
Speaker 1: much as a whole different but I think almost entirely,
16:54
Speaker 1: isn't it Big Farmer hasn't been um made a part
16:59
Speaker 1: of this almost at all, that it's not a part
17:01
Speaker 1: of healthcare form. Well, this might be a way to
17:03
Speaker 1: make them more accountable. Um is these panels that will
17:06
Speaker 1: evaluate cost effectiveness of treatments. But let's re emphasize again
17:11
Speaker 1: that these panels are not designed to say to you
17:13
Speaker 1: you can't have the drug. It's just saying, we think
17:16
Speaker 1: this drug is the most cost effective, why don't you
17:19
Speaker 1: try that before trying one that is more experimental may
17:22
Speaker 1: not work as well, so on and so forth. It's
17:25
Speaker 1: not designed to get between a doctor and a patient. Okay, good,
17:29
Speaker 1: And I guess the last point um that I keep
17:31
Speaker 1: hearing about ration in healthcare. It's very delicate, but there's
17:34
Speaker 1: a lot of people who say, you know, we kind
17:37
Speaker 1: of need to ration healthcare. You pointed out that health
17:40
Speaker 1: care is already ration by the health insurance companies, right,
17:44
Speaker 1: you know, by um annual limits or lifetime maximums for
17:49
Speaker 1: care UM and by denying coverage to people with pre
17:53
Speaker 1: existing conditions. But um, I think this, this whole idea
17:57
Speaker 1: that we may need ration care UM is kind of
18:00
Speaker 1: based on an idea that the average patient abuses this
18:05
Speaker 1: health care infrastructure. Right, that there's so much available and
18:10
Speaker 1: we have so little conception of value to actually what
18:14
Speaker 1: we're taking advantage of that will say no, no, I
18:17
Speaker 1: want the m R I and that Cathy. I think
18:18
Speaker 1: we touched on that in the first one didn't, And
18:20
Speaker 1: I think that's that's fair for both sides to say
18:22
Speaker 1: the patient probably wants more care and more care because
18:24
Speaker 1: we have a lot of people who know what's out
18:26
Speaker 1: there for them to take advantage of. And then I'm
18:28
Speaker 1: sure you also talked touched on that doctors are paid
18:30
Speaker 1: for every service they provide to a patient, and so
18:33
Speaker 1: there's incentives on both sides for doctors patient for the
18:36
Speaker 1: same thing. Even if it's not working, you feel better,
18:38
Speaker 1: and so Medicare with this bundling is going to be
18:41
Speaker 1: sort of the testing ground for trying to do this
18:43
Speaker 1: within our system as a whole. That's the ideal. I
18:45
Speaker 1: don't know if how it will shake out in the end,
18:47
Speaker 1: but so can you say definitively whether rational ng healthcare
18:52
Speaker 1: is number one a myth or truth that it's going
18:55
Speaker 1: to happen. Well, if we take Britain's definition of what
18:58
Speaker 1: rational health care is in terms of a UH panel
19:02
Speaker 1: making a choice whether you can or cannot have the drug,
19:04
Speaker 1: then no, there's nothing in these bills that would do that. Um,
19:08
Speaker 1: whether eventually there would be you know, fewer services and
19:10
Speaker 1: fewer of these people going in and getting every single
19:12
Speaker 1: service they asked for, it's possible that might that might decrease,
19:16
Speaker 1: but that could be a good thing. It could it
19:18
Speaker 1: could be Ultimately. You can make the point that this
19:20
Speaker 1: is very similar to UM, government prohibitions on drug use
19:24
Speaker 1: or something or um, you know, you have to be
19:26
Speaker 1: a certain age to buy tobacco or to buy alcohol. Um,
19:30
Speaker 1: that's pretty much arbitrary. And this is actually a little
19:33
Speaker 1: more focused saying no, we have this huge infrastructure, you
19:35
Speaker 1: guys are costing us two point four trillion dollars a year,
19:38
Speaker 1: a lot of it unnecessary. So I don't you could
19:41
Speaker 1: argue the point that maybe somebody does need to step
19:44
Speaker 1: in and say you can't do this because that's stupid.
19:47
Speaker 1: That's true. But then on the other hand, you've got
19:48
Speaker 1: someone who takes, you know, nine tests and the tenth
19:51
Speaker 1: one would have been the one that worked. And if
19:53
Speaker 1: they feel in any way that they didn't get that
19:55
Speaker 1: tenth test because of you know, they already got nine,
19:58
Speaker 1: then that's where people start to get worried. Is there
20:01
Speaker 1: any mechanism to um sue the pants off of the
20:04
Speaker 1: person who denied you that tenth test? Well that would
20:08
Speaker 1: currently we've got the whole medical malpractice thing, right, But
20:11
Speaker 1: if it wasn't a physician, if it was a government
20:14
Speaker 1: panel or something like that, could you sue the government? Yeah,
20:17
Speaker 1: it could get very hinky. You know, some of the
20:20
Speaker 1: decisions that the Nice Panel makes are controversial. I mean,
20:23
Speaker 1: they deny a lot of really expensive cancer treatments and
20:25
Speaker 1: as a result, Britain has um you know, worst cancer
20:29
Speaker 1: survival rates in the US. Does whether someone has tried
20:33
Speaker 1: to sue, I don't think so, but um, because you
20:35
Speaker 1: can pay in England right. Our colleague Lee Dempsey pointed
20:37
Speaker 1: out yesterday that you can actually pay better care. That
20:42
Speaker 1: was awful that everyone I just wanted to apologize to
20:46
Speaker 1: leave for Chucks terrible, terrible impression of his British act.
20:49
Speaker 1: He's actually not from England. He's from a small island
20:52
Speaker 1: that's not been yet named Manoa, and they have a
20:54
Speaker 1: very odd accent there. So, guys, um, I don't know
20:57
Speaker 1: a good way to put this. Let's talk about abortion.
21:01
Speaker 1: Is it a myth? That's a great icebreaker, by the way,
21:04
Speaker 1: for your next dinner party, Josh, you should keep that
21:07
Speaker 1: in your cral. You know. That's how a lot of
21:09
Speaker 1: episodes of stuff Mom never told you start out. If
21:12
Speaker 1: anyone's interested, Christa and I just go, let's talk about
21:14
Speaker 1: abortion really, So we highly recommend you go listen to
21:17
Speaker 1: that podcast. But women's issues it's a big thing, you know. Obviously,
21:20
Speaker 1: people who want women to have the right to an
21:22
Speaker 1: abortion would like to see abortion be a necessary benefit
21:26
Speaker 1: included by the government. What the what these bills provides
21:28
Speaker 1: the government to come in and say these are things
21:30
Speaker 1: that insurance plans have to cover to be considered valid
21:33
Speaker 1: insurance plans. Right, the minimum coverage right. So there's a
21:36
Speaker 1: big debate about a lot of things that be covered,
21:38
Speaker 1: like mental health, how much will that be covered? Abortion
21:40
Speaker 1: is the big one that is dicey because no, you know,
21:44
Speaker 1: no um anti abortion person wants to pay for someone
21:46
Speaker 1: else's abortion, right. So how the House is compromised on
21:50
Speaker 1: this is that help promers can choose whether to provide it.
21:53
Speaker 1: It doesn't necessarily have to be one of these essential benefits,
21:55
Speaker 1: but it can be. And if you do get an abortion,
21:58
Speaker 1: the thinking is that you would pay not with these
22:01
Speaker 1: public subsidies that are available to people, but you'd have
22:04
Speaker 1: to pay out of pocket for that unless it was
22:06
Speaker 1: one of the abortions that's defined as um you know,
22:09
Speaker 1: in the gray zone. The rape sort of abortion Senate
22:14
Speaker 1: Senate Finance Committee bill as it stands now prohibits funding
22:18
Speaker 1: accepting cases of rape, incest, or endangerment to the woman's
22:21
Speaker 1: life right. And that's I mean, that's the bill. I mean,
22:24
Speaker 1: that's the plan that a lot of like Congress people
22:26
Speaker 1: for example, have The government alright currently pays for abortions
22:29
Speaker 1: under those qualifications. And also the Finance Committee bill, which
22:33
Speaker 1: is just released yesterday, And but you said it's not
22:35
Speaker 1: the final version. Right, it's his mark, so it'll still
22:38
Speaker 1: go through the Senate Finance Committee. It's the chairman's mark.
22:40
Speaker 1: On abortion, they continue to say that the bill would
22:42
Speaker 1: prevent abortion coverage from being included in a minimum benefits
22:46
Speaker 1: package and uh in the health insurance exchanges where you
22:51
Speaker 1: shot for the coverage, but the plans in exchange could
22:54
Speaker 1: include uh, they could offer abortion coverage as long as
22:57
Speaker 1: no government subsidies pay for it. And still the coverage
23:00
Speaker 1: would be funded through member payments, which are segregated from
23:03
Speaker 1: the federal money. So that's what the Finance committees. Yeah,
23:06
Speaker 1: so that's consistent with how the House had it as well.
23:09
Speaker 1: Is it um? And basically the thinking is that any
23:11
Speaker 1: given area, you should be able to choose one plan
23:14
Speaker 1: that has abortion covered in one plan that doesn't. But
23:16
Speaker 1: they would be I saw this in your article too.
23:18
Speaker 1: They would be um, the same plan except one covers
23:23
Speaker 1: abortion and one doesn't, okay, But everything else is the same, okay,
23:28
Speaker 1: and they'd be the same price, I imagine, right, I
23:29
Speaker 1: would think, So, yeah, what for the total plan, the
23:32
Speaker 1: total bill. If you're in the marketplace, those insurance marketplaces
23:36
Speaker 1: we were talking about, you should have a choice of
23:39
Speaker 1: a plan that has abortion and a choice of planet
23:41
Speaker 1: that you would have, like a premium abortion pro plus
23:45
Speaker 1: and then premium no abortion plus plan right next to
23:49
Speaker 1: each other, and they should be the same the same cost,
23:52
Speaker 1: just to give people a choice. I thought you talking
23:53
Speaker 1: about the total bill, because to Senate finance bills about
23:56
Speaker 1: a hundred and fifty billion dollars cheaper. Do you remember
23:58
Speaker 1: how when we went into the market place and we're
24:00
Speaker 1: looking at all those insurances there, I get it. So
24:04
Speaker 1: you can be pro choice, choice, You can have the
24:07
Speaker 1: choice to have the plan that has the choice. My
24:11
Speaker 1: mind is melting all over the table. All right, um, guys,
24:13
Speaker 1: can we talk about something that President Obama loves to say.
24:17
Speaker 1: It's usually the first thing he kicks off with, if
24:19
Speaker 1: you like your insurance plan, you can keep that plan.
24:23
Speaker 1: Molly Edmond says that that is not necessarily true if
24:25
Speaker 1: you start looking down the road and read between the lines, right,
24:28
Speaker 1: you know. The thing is is, when um Obama went
24:30
Speaker 1: out the summer did his town halls. I think that
24:33
Speaker 1: if he had a nickel for every time he told
24:34
Speaker 1: people that if you like your plan, you can keep it,
24:36
Speaker 1: he would have enough to find healthcare reform. Right. But
24:39
Speaker 1: I think if you were paying attention to the speech
24:41
Speaker 1: he made, the famous speech to Congress, you will notice
24:44
Speaker 1: that that phrase did not appear in the speech because
24:46
Speaker 1: I think he's realized that he can't promise people that
24:49
Speaker 1: their plan will stay exactly the same under these reforms.
24:53
Speaker 1: We're saying you can keep it, though not necessarily that
24:55
Speaker 1: would be the exact same plan that you're keeping. Well,
24:57
Speaker 1: but that was how he was sort of pitching it is,
24:58
Speaker 1: if you like your doctor, you can have your doctor.
25:00
Speaker 1: And the fact of the matter is is that your
25:03
Speaker 1: plan is going to change, all right, to build in
25:04
Speaker 1: these consumer protections. So that's a great change. You know,
25:07
Speaker 1: you won't be able to be dropped by insurance company.
25:09
Speaker 1: They can't just discriminate for pre existing conditions UM. And
25:13
Speaker 1: then your plan will have about five years probably to
25:16
Speaker 1: come up to speed with all these other plans. It'll
25:18
Speaker 1: be grandfathered into that minimum set of benefits we were
25:21
Speaker 1: talking about UM. But you know, in that marketplace when
25:25
Speaker 1: they start UM competing for all these uninsured customers, we
25:29
Speaker 1: don't know what current plans will have to do to
25:31
Speaker 1: stay financially viable. Right, They may have to slash services,
25:35
Speaker 1: they have to slash services. That kind of stuff happens anyway,
25:38
Speaker 1: though your insurance plan probably isn't the same today as
25:41
Speaker 1: it was five years ago without all this government competition,
25:44
Speaker 1: that's true. And the thing is, if you don't know
25:46
Speaker 1: how your plans change over the five years, you may
25:47
Speaker 1: not notice how your plan changes when this happens to right. Yeah,
25:51
Speaker 1: I don't know. Well, first of all, it didn't have
25:53
Speaker 1: insurance five years ago, But I couldn't tell you what
25:55
Speaker 1: it looked like last year. You know, you're living in
25:58
Speaker 1: the mountains. That is the in my car, Okay. I
26:01
Speaker 1: mean the only way you're gonna know is if you
26:03
Speaker 1: go to the doctor and all of a sudden they
26:04
Speaker 1: don't accept your insurance, or if something that used to
26:07
Speaker 1: be covered um isn't covered anymore. But that's just so
26:10
Speaker 1: speculative right now that it's impossible to say one way
26:12
Speaker 1: or the other whether you know things will be the
26:14
Speaker 1: same or not. I think a lot of this, from
26:16
Speaker 1: what I'm reading, is like the outlines in place, But
26:18
Speaker 1: who knows how all this is going to shake out.
26:20
Speaker 1: Sometimes you have to wonder if we have to believe
26:24
Speaker 1: the best about people are the worst about people. Well
26:26
Speaker 1: that I think what it comes down to, I keep
26:29
Speaker 1: running across you mentioned, um that this whole thing is
26:32
Speaker 1: a ror check test or the public option is a
26:34
Speaker 1: Rorschach test. And really what it comes down to is
26:36
Speaker 1: can you trust doctors to not skinch on healthcare when
26:39
Speaker 1: they're being paid and bundles skinch skinch you okay if
26:46
Speaker 1: it's not it is said, I love it? Yeah. Um.
26:49
Speaker 1: Can you can you trust that the government panels won't um,
26:54
Speaker 1: you know, stifle innovation like it does, undercut the insurance
26:58
Speaker 1: company so much or they can't stay in sure? Can
27:00
Speaker 1: you trust Obama that this isn't really a planned to
27:03
Speaker 1: ultimately create a single payer system? Right? And can you
27:06
Speaker 1: trust individuals to take it upon themselves to like doctor
27:09
Speaker 1: Royson is a big advocate of to to take on
27:11
Speaker 1: preventative care, the burden for health is on the patient
27:14
Speaker 1: as much as is the doctor or not. I don't
27:16
Speaker 1: think that mindset is clear to a bunch of Americans. Well,
27:19
Speaker 1: but I think that that's what they're using as an excuse.
27:21
Speaker 1: I mean, someone who would be against a big public
27:23
Speaker 1: option or really subsidized health care would say, this person
27:27
Speaker 1: got themselves into this mess because they smoked or their
27:29
Speaker 1: overweight or so on, and so looking at just what
27:33
Speaker 1: the mistakes of one person made is like not seeing
27:35
Speaker 1: the forest for the trees. So all these pieces are
27:38
Speaker 1: working together in a way that we can't isolate blame
27:41
Speaker 1: at anyone. But that's what this discussion has turned into.
27:43
Speaker 1: Saying that you know, the worst is going to happen
27:47
Speaker 1: about these people, agreed. And actually, when we spoke to Royson,
27:50
Speaker 1: if I can bring them back again, um, he said
27:53
Speaker 1: that apparently basically us not caring at all about our
27:57
Speaker 1: health is costing this country me more than any other
28:01
Speaker 1: sector of the health care of health care spending. Um.
28:04
Speaker 1: He put it like this, of all healthcare costs are
28:09
Speaker 1: caused by chronic disease that is caused by four factors tobacco,
28:15
Speaker 1: food choices, and portion size, physical inactivity, and stress. So
28:20
Speaker 1: we can reinvigorate primary care by paying physicians to teach
28:26
Speaker 1: these things because what gets paid for gets done, and
28:31
Speaker 1: what gets done gets taught well. So in fact, we
28:34
Speaker 1: have a tremendous opportunity of paying physicians to do this
28:37
Speaker 1: and saving a huge amount of money. In fact, if
28:42
Speaker 1: all we do is a program, um, and I'll go
28:47
Speaker 1: to the exact bill, it's called take back your health.
28:51
Speaker 1: That does this for five diseases coronary disease, type two diabetes,
28:56
Speaker 1: metabolic syndrome, breast cancer, and prostate cancer. We save after
29:01
Speaker 1: paying for it. We save one point nine trillion over
29:05
Speaker 1: ten years. So clearly, as Royson pointed out, Molly, you
29:10
Speaker 1: are right. I mean, it comes in very large part
29:13
Speaker 1: comes down to us changing our perception about our own
29:16
Speaker 1: health and taking responsibility for him. Right, let's do one
29:19
Speaker 1: last one, you guys mind, since we're not doing listener mail. Okay,
29:23
Speaker 1: let's do it, Josh, are we moving towards socialized country
29:27
Speaker 1: this one? Well, do you know the definition of socialized country, CHUCKA.
29:34
Speaker 1: I do not, Josh, go state owned and operated industry.
29:40
Speaker 1: So not only is the government paying your bills, they're
29:42
Speaker 1: hiring your doctors and running your hospitals. So that's what
29:45
Speaker 1: Britain does. And then there's also a fear of a
29:47
Speaker 1: single payer system, which, um, you know, Obama has a
29:50
Speaker 1: few choice quotes that people like to pull up saying
29:52
Speaker 1: that he would like a single payer system. Right, that's
29:55
Speaker 1: what Canada has, where all the bills just go straight
29:57
Speaker 1: to the government, no questions asked, hi Wan, Right, doesn't
30:00
Speaker 1: one actually let's say that, because we're gonna talk about
30:02
Speaker 1: healthcare systems from around the world in the next one.
30:05
Speaker 1: So most countries have some form of single pair, but
30:08
Speaker 1: whether um, we've been promised a uniquely American system because
30:13
Speaker 1: we are a uniquely American country too late at this point,
30:16
Speaker 1: don't you think. I mean, even if we wanted to
30:18
Speaker 1: switch to socialized medicine, we couldn't do it now. I
30:21
Speaker 1: think you could over the course of May. But you know,
30:27
Speaker 1: we're certainly not there with these proposals. There's no need
30:29
Speaker 1: to fear these specific bills as any sort of move
30:32
Speaker 1: towards um single pair or socialized medicine. Well, I think
30:36
Speaker 1: one of the concerns though, is that this uh this
30:38
Speaker 1: public option uh is will eventually run the other insurance
30:43
Speaker 1: companies out of business and then we'll have a de
30:47
Speaker 1: facto single payer system because the only man left standing
30:50
Speaker 1: will be the public option, right is that is that
30:54
Speaker 1: one of the fears the concerns that that is a concern. Um,
30:57
Speaker 1: the public option is so in the air right now,
30:59
Speaker 1: that would be hard for us to making a sort
31:01
Speaker 1: of conclusion my whether that's a myth or not. You know,
31:03
Speaker 1: the thing that just came out this week. Um, the
31:06
Speaker 1: Senate Finance Committee one that's can get all marked up.
31:08
Speaker 1: That went for co ops, so we know how will
31:11
Speaker 1: a co op work in this system versus what would
31:14
Speaker 1: a public plan be? So that right now is is
31:17
Speaker 1: such a shadowy thing that I think we should have
31:19
Speaker 1: avoid speculating on it. Okay, agreed, agreed. No, we don't
31:23
Speaker 1: want to stir up any more fierce as the whole
31:24
Speaker 1: point of this podcast was to allay them pretty much, right,
31:27
Speaker 1: or at least say no, you're running. You should be
31:29
Speaker 1: scared out of your mind. Here's my guess. I don't
31:31
Speaker 1: think they could do anything to put every insurance company
31:33
Speaker 1: out of business. No, that's what I think. I think
31:36
Speaker 1: the one of these call me in ten years, if
31:39
Speaker 1: there are no more private insurance companies in America, They'll
31:42
Speaker 1: buy you a beer. Really, yeah, anyone out there? Yeah,
31:46
Speaker 1: of course I'll be dead, and ten years you will
31:48
Speaker 1: be because they've rash in your healthcare. Exactly. You faced
31:51
Speaker 1: the death panel. No, I want to live. You signed. Sorry, guys,
31:56
Speaker 1: that's about it, right, you got any more myths you
31:59
Speaker 1: want to cover? I know him? Illegal immigrants? Yeah? Oh,
32:05
Speaker 1: you thought you were getting away without talking about this. No,
32:07
Speaker 1: this is a big one. As I saw actually in
32:10
Speaker 1: the House bill. It's it's basically says, actually, it does say,
32:15
Speaker 1: if you're born in the United States and you're not covered,
32:18
Speaker 1: you're automatically covered. Does that amount to covering illegal immigrants? Now,
32:22
Speaker 1: not necessarily the people who are you know, um, that
32:26
Speaker 1: same day labor who went into the e er Right, Um,
32:31
Speaker 1: we're not talking about him necessarily. But the children of
32:33
Speaker 1: illegal immigrants would be covered under that language, right, So,
32:37
Speaker 1: I mean that is technically correct that illegal immigrants would
32:40
Speaker 1: be covered. Well, no, their children will be covered, right,
32:43
Speaker 1: but they themselves, the children would be considered illegal. No,
32:47
Speaker 1: they know, if you're born on American soil, you're an American.
32:50
Speaker 1: Excellent point. There's no legist there. I mean, it's not, Um,
32:54
Speaker 1: there's no no law that says that. But it's generally
32:56
Speaker 1: thought that if you're born on American soil, you're American citizens. Okay,
33:00
Speaker 1: So technically they wouldn't. It wouldn't cover legal immigrants, does
33:02
Speaker 1: it in any other way? Well, the way it was
33:04
Speaker 1: explained to me is that illegal immigrants would not be
33:08
Speaker 1: able to receive any sort of subsidies because there'd be
33:10
Speaker 1: too much Um, need for proof about where they were
33:13
Speaker 1: born and where they all their paper ark would have
33:15
Speaker 1: to be in order to get these subsidies. Um, but
33:18
Speaker 1: as possible, they would be able to enter the exchange
33:20
Speaker 1: and buy insurance because um, they would be you know subject.
33:26
Speaker 1: I mean, there's nothing that would keep them out of
33:27
Speaker 1: the market place. I want to pay. Then, welcome to
33:30
Speaker 1: the to the game. Well, but some people aren't ready
33:32
Speaker 1: to stay. Welcome to the game, right, Molly. I am
33:34
Speaker 1: looking forward to your second career as a diplomat. Seriously.
33:38
Speaker 1: Thank you again for coming in, and we'll see you
33:40
Speaker 1: next time when we cover another one of your articles,
33:42
Speaker 1: which just health care systems around the world and how
33:45
Speaker 1: they compare to the US. Dr Royson's gonna be back, yes,
33:48
Speaker 1: so we'll Chuck's goatee. We'll talk about different countries. People
33:50
Speaker 1: are already emailing saying what about us in Canada and England,
33:53
Speaker 1: and Chuck's been responding with pipe down. We're going to
33:56
Speaker 1: get to you right. Keep your pants on it. If
33:58
Speaker 1: you're looking for a place to move. I think that
34:00
Speaker 1: that podcast will be really helpful. Okay. In the meantime, UM,
34:04
Speaker 1: you can basically take advantage of Molly Edmonds giant sponge
34:08
Speaker 1: like brain uh and learn everything you need to know
34:11
Speaker 1: about healthcare reform by typing healthcare reform in the handy
34:14
Speaker 1: search bar at how stuff works dot com. And by
34:17
Speaker 1: the way, if you want to send us an email
34:19
Speaker 1: praising us, condemning us, telling us that we're in favor
34:22
Speaker 1: of illegal immigration, whatever, just send it to stuff podcast
34:26
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34:34
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34:36
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34:45
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