I Don't Know About That - Health Insurance

Episode Date: January 4, 2022

In this episode, the team discusses health insurance with Distinguished Professor of Health Policy and Management, Thomas Rice. Make sure to check out Thomas Rice's book "Health Insurance Systems: An International Comparison". Go to JimJefferies.com to buy tickets to Jim's upcoming tour, The Moist Tour.See omnystudio.com/listener for privacy information.

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On I Don't Know About That With Jim Jeffries Jack Halligan Kelly Blackheim Forest Treeshaws Okay well that's all So this episode's over Tune in next week

Side by side of my piano. Jack Halibut. Hey, fellas. Louise Trout. Jack Halibut. That's kind of a cool name. Forrest Grouper. I don't know.

Jack Halibut. Jack Halibut. You should rebrand yourself. My wife, I was watching the golf and Tiger was playing with his son, Charlie. And my wife goes, oh, his son's called Charlie as well. And I said, yeah. And she goes, Charlie Wood.

Oh, that's a nice name. I go, he's 14. Calm down. She's like, oh, Charlie Wood. He's going to be wealthy. There he is. You got some dates? Columbus, Ohio, Kansas City, Des Moines,

Iowa. They're all in January. Faris, read them out. Pittsburgh, January 14th. Columbus, Ohio, January 15th. Kansas City, January 28th. And Des Moines, Iowa, January 29th. I'll be at the Philly Punchline January 20th. Please come Moines, Iowa, January 29th. Woo-woo. I'll be at the Philly Punchline January 20th.

Please come see me. Please. They're all selling very well except for one gig, which is selling abysmally. I thought you were talking about me. One gig, I don't know what's going on. I can't sell a ticket. It's selling terribly. Do you want to say it?

I'm not going to tell you which one it is. Then you won't want to come. Okay. Or you will because you have a better chance of being close i don't know no that works no it's still fine um we got a little different thing we're doing here now because we do the uh uh patreon you're not going to get jack second anymore if you want to do it join the patreon where we shoot the shit it's a more free type of a show we might talk about the episode that we just did um but we let's start the episode yeah okay let's introduce our guest please welcome our guest

thomas rice good day thomas um now it's time to play yes though yes yes yes judging a book by its All right, so Tom is... I think you can call him Tom, right? Yeah, Tom. Tom works. Okay, so I think that you're a Tim Rice cover band and you wrote the lyrics for all of Andrew Lloyd Webber's musicals. Close, but I have no musical talent at all. Oh, he's just a lyricist.

He's just a poet. That's why you bring weber in um okay so all i can see behind you is a door and a lamp and a small ventilation bit at the top there it's a heater i assume curtain and the exchange for the air conditioning and air conditioning exchange yeah there's a thing uh so there's nothing really to tell um could i call you doctor doctor you could but tom works perfectly I call you doctor, doctor? You could, but Tom works perfectly well. But you are a doctor? I am a PhD type doctor, not a medical type doctor. Okay, so you're a doctor of history?

No. Oh. Can your doctorate heal people? No. Just the doctorate itself, the piece of the piece of paper yeah no maybe he's a thing my psychologist thing it's not a it's not a medical is it i guess it is uh it's in the realm of medicine we're going to be talking about today though oh it's in the realm of it um are you an expert in uh we've already done vaccines um pandemics. Is it a hot button subject? Yes. All right.

I would say so, yeah. Always. It's always. So is it vaccines? No. A different angle. We're doing a different angle on vaccines? We're running out of things.

What are vaccines a part of? I mean. Antibodies. No. It's like a much broader topic. Oh, medicine. Yeah. Well, I'll give you a hint here. What is a lizard?

Yeah. I can't think of anything else. I don't even know where you're... I can't help you with this. I have no idea where you're going. There's a commercial with a duck. Oh, health insurance. Yeah, that's what we're doing. I got a duck. That's a duck. Health insurance. Yeah, that's what we're doing. That's it.

I got a lot of opinions on health insurance. I'm going to get myself in trouble here. Fucking hell, people get angry. I got friends who I think are smart people who don't agree with me on health insurance. Well, here we go. Tom Rice is a distinguished professor of health policy and management at the UCLA Fielding School of Public Health. He's a health economist who studies health insurance and international health care systems. Tom has written several books on health care economics and systems this past year.

He published a book that compares the health insurance systems of 10 countries, the United States and nine other high income countries. And the book is called Health Insurance, health insurance systems and international comparison. I don't know how you came up with that title, but I'm fascinated by this. I'm sure over the course of the podcast, you'll tell us where everyone ranked or thereabouts, but I can't, I can't see America being top of that list of top 10.

That's gotta be right fucking down the bottom. And if it is, I'll be shocked because I've lived in Britain, I've lived in Australia, I've lived in America, and I've got money, so it doesn't make a difference to me. But the health insurance here, they're not doing a good job. They don't know what they're doing, in my opinion. Yeah, we'll see.

I mean, that's your opinion too. I think it's most America's opinion, but we'll talk, we'll talk about it. Oh no, not if you bring it up with this fucking accent. If you say it, you might find some allies. Not with this fucking accent. I'll tell you what, I'm just told to go home. If you don't like it, leave. Right now there's someone in their car.

They're going to drive their fucking, fucking pickup truck off the side of the road. You'll don't do it. You won't get any medical care. You'll just be injured forever. It'll cost you a lot of money. Tom, you said you have a PhD, but it's not in medicine, even though this it talks, this is in the field of medicine,

health insurance. So the, the PhD is in economics. Is that right? Okay. There you go, Jim. So it's not always philosophy or medicine. I can even rank you what's got the best healthcare service out of the different countries I've lived in and other countries I've visited. I have my opinion. I think I can get this all right. All right. Well, let's see. All right. So, all right, Tom. So I'm going to ask Jim some questions about health insurance and things in

that nature. And you're going to grade them at the end of these questions, zero through 10, 10 being the most accurate, because I'm of unconfidence, I'm going to grade them on et cetera. We'll add those together. 21 through 30, PPO. 11 through 20, PB&J. Zero through 10, POS. Which actually is a type of insurance I found out later. That's what we give the people that work on this podcast. Piece of shit insurance. Health insurance. I mean, you know what it is, right? Yes.

It's like all insurance. It's a small amount of money that you pay to guarantee that if something bad happens to you, they can pay a larger amount of money than the small amount of money that you paid so that you'll get better. It's the same as any other insurance on anything else that you purchase in your life. It's coverage to make sure you're covered for a rainy day. What was the first law passed in the United States in regards to health insurance? Fuck me. It would have been something after

one of the wars. They would have come back and said, we probably have to do something with these people who have come back from said we probably have to do something with these people who have come back from the war or something they probably did some type of government health care like thing then i'm going to say 1920 okay um oh you didn't ask the year was the affordable cares act i don't know okay the affordable care i know that's a new one. Okay. When did health insurance, as we know it, first come into existence? In America or worldwide? Well, you know, in general, yeah. I believe the NHS, National Health Service of the UK,

I believe that came into action after the Second World War. So I'm going to say 1945 or early 1950s that was introduced into britain i don't think you ever had universal health care over here i don't know how long the canadians have been doing it but i believe i would say similar thing after the country started having national health care after the second world war but i think there was probably talks about it before then okay there's a question that got moved here that i can't find about a young person why i think i can why would a young person of good wait a minute i'll tell you why i think it's after the second world war i'll just feel you know why i just watched a documentary on charlie chaplin charlie

chaplin grew up in england and everyone around him didn't have any health insurance and stuff like that and he came up through the 1920s and all that type of stuff. And then into the silent movies and everything that we know about him. And he died in, I think the early 1970s or something like that. Anyway, but, but he, he didn't have healthcare in between the first and second world war in Britain. There was illnesses. His mother had an illness, a mental illness, and it wasn't covered by healthcare. So that would be covered now.

So that's why I'm using that argument. Why would a healthy young person want to spend their hard-earned money on health insurance? Because a healthy young person can still get themselves into an accident. They can still one day wake up and have cancer. It's something you don't want to go bankrupt if you do. If you just break a leg, you need health insurance. You have a cold, you need fucking health insurance. That's the first bill you should be paying out of your wallet is to make sure you and your family have health insurance. That's right up there with food, in my opinion. All right, in the United States,

what type of health insurance is in the United States? It's just private health insurance that can be given to you. Mostly Americans do it through their occupation, which isn't as common as other countries. Other countries will have. There's no public health insurance in the United States? There is. You can go to emergency rooms and stuff like that and get some stuff.

And there's Medicaid and all this stuff, but there's nothing good. There's nothing that you really want that's public. So what's the difference between Medicare and Medicaid? I don't know. I don't know. I just know that it's fucking, mine's about to run out and I'm going to start paying for it again. Wait, your Medicaid or Medicare is about to run out?

My blue whatever. This is the problem with American health insurance. You've got blue ribbon. You've got blue what's your name? Blue cross. Blue cross. Blue shield. You've got blue shield.

All these blues are kicking about. And then you go down. You'll go to it. I went to my dermatologist. I've been going to it forever. And they go, we don't take blue shield anymore. anymore and he's like what the fuck is the point of this fucking thing my my baby needed a small medicine and they go them the for whatever reason the healthcare doesn't cover this particular medicine i don't give a fuck i'll just pay for the fucking

medicine but there's people who would give a fuck right right and it's like all the time they just put up roadblock roadblock road, roadblock, roadblock. Now, the best healthcare systems you can use is the system they use in both Australia and Britain. I'm sure France has an excellent one as well. Canada? Canada's not as good. Canada's not as good.

And I'll tell you why Canada's not as good, because you have to have it. It doesn't matter if you're the prime minister to the homeless person. You have to have health insurance. You can't opt out and get yourself better insurance on top. So in Britain, you can have your health insurance, which is very good, and you can see the same doctor on the public health insurance. But if you want to see him a couple of weeks earlier

and you've got a brand called Bupa, right, you can slap private insurance on top. So I used to pay £50 a month for Bupa, which was nothing, and then I had private. That was just. And then I had private. Bupa. That was just the company. I had private on top of my other one. Australia, same thing. You can have private on top of your other one. I prefer the Australian model ever so slightly better

because everybody gets a Medicare card in their wallet. They can have like a credit card that has all their information. So you just go into a doctor's office, you hand over the card, and you're not filling out forms. Everything in America is, you're sick, you're feeling bad, here's fucking 15 sheets. Okay, this is an opinion.

Just so you know, in the questions, I did write something in here, and I said, rant on health insurance, this will happen for sure. So I predicted that right in here. Almost in the exact spot, Tim. Yeah, it really did. All right, rapid fire. Just say what these mean. These are abbreviations.

You lead a horse to water, man. PPO. PPO. P-P-O. Rapid fire. No. Oh, there's a gun jam. Pay for something yourself.

HMO. I don't know all this stuff. I don't know what E-L-L-L means, and I'm a fucking comedian. Oh, yeah. Laugh out loud. Yeah-L-L-O-L means. And I'm a fucking comedian. Oh yeah. Laugh out loud. Yeah. There you go. Or lots of love.

R-L-L-O-L-Z. Okay. You don't know any of these. What percentage of Americans have health insurance? 70%. Okay. Affordable Care Act. What's that?

When did that come out? I think, I think that's Obamacare. I believe. Has it been effective? Obamacare. It depends who you speak to. think that's Obamacare I believe. Has it been effective? Obamacare, it depends who you speak to some people hate Obamacare because I didn't get to see my regular doctor, I had a doctor I like to see

why does he sound like that? because that's the ones that complain, they always have that voice I think that it did work, I know a lot of people who benefited off Obamacare because all of a sudden they could afford healthcare and they couldn't before.

And then people were saying it cost them more because their other healthcare was better. People weren't happy, but other people were happy. I would say it was probably a step in the right direction. All right. We'll ask a couple more questions and we'll come back to some of these. What is the American Medical Association, AMA, and what is their role in shaping US healthcare?

American Medical Association is AMA. Yeah, but like what is it? What do you mean? Okay. What was their role in like shaping like health insurance? Oh, they probably police the health insurance and make sure that when they, because one of the big problems with health insurance is you go, oh, I've got coverage. But at any stage they can say to you, oh, we don't think that treatment's appropriate.

We don't think that you should do this. We're not paying for that while you have the insurance. And that's where the problems come because you're just like, well, I want to have this fucking treatment. Meanwhile, they've got adverts on TV in America telling you to tell your doctor what fucking medicines to give you, and the doctor should be telling you what medicines you should have. At no stage should you go to your doctor,

I just watched an ad, I think I need liposil or some fucking bullshit. JJ has a bit like that. It's a load of rubbish that you should be talking about. Your doctor should tell you. Okay. On average, how much do Americans spend on health care each year? Per person? Okay, so.

You can do in total or per person? When my medical insurance covers out, they're saying that I'm going to have to pay about two grand to keep my medical insurance at the level I need for my family for a month that I want. And so I'm going to say the average person spends 10 grand a year. Okay. What is a charge master? He's the bloke at the front of the

army with a sword who yells charge. Probably called the charge master. Maybe, yeah. Here's a couple more questions. Um, I don't know. Do you, do you know what an ambulance ride would cost? Like just this, I'll tell you this.

I had an ambulance ride in Australia and it didn't cost me fucking anything. And I didn't have any insurance. I was just being an idiot. He had a party and I needed an ambulance and the ambulance came and got me. And then that was it. So in America. Two, I'm going to say five grand.

I'll tell you another one. I had a head injury in Britain. They took me into the hospital. I spent two or three days in the hospital because I was getting headaches and they were wondering if I was bleeding on the fucking brain. At no stage did they ask what my real name was. And when I left, I didn't have to check out or anything. I just walked out.

That's amazing. Not a single form was filled out. I meant to ask you this. It didn't cost to check out or anything. I just walked out. That's amazing. Not a single form was filled out. I meant to ask you this. Didn't cost me a cent. What percentage of Americans believe the government should ensure people have health insurance? I would say that that would be 50% of the population because we all know we're divided 50-50 in this country.

There's some people who say the government shouldn't have anything to do with my health insurance or whatever, and that's their big fucking gripe. But I'm telling you people, it's the best public health care. It's the best. Okay. And then one more question that's up here, and then I'll ask some of these other ones.

What countries have a similar system to the United States? I don't think maybe there's some south american countries or something like that okay maybe some south american all right um i don't think there's anything in europe like that all right we're gonna take a quick break and read some ads and be right back using the internet without express vpn is like leaving your keys in your car while you run into the glass window or into a gas station for a snack. Most of the time, you're probably fine unless the glass breaks or you go into the thing and there's no snacks and then you've got diabetes and you can't get to your insulin in time. Is this an ad?

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What have you got to protect? Is that someone else's slogan? I just threw it. Is that another company? No, that's great. I'm sure they're going to use that now. Okay, Tom. On zero through 10, 10 being the best,

how did Jim do on his knowledge of health insurance? On zero through 10, 10 being the best, how did Jim do on his knowledge of health insurance? Well, I would say he did nine on the forest and about five on the trees. So I'll give him about a seven. Yeah, I like that. Yeah, I don't know the finer points, but I know the big picture.

Nine on the forest and five on the trees. I don't know if I've ever heard that, but I get it. Yeah, cool. Confidence, how do you do, Kelly? I think probably about a six on confidence. Do you call your penis a tree? No, I don't. You should. Yeah, you. Confidence? How do you do, Kelly? I think probably about a six on confidence. Do you call your penis a tree? No, I don't. You should.

Yeah, you're a forest. I don't think any women would like that at all. The mighty oak. How about that? Mighty oak? Maybe. I don't know. The weeping willow.

That's after a whiskey. That's not going to help. So that's a 13 total. I'm going to just give you a 5. You have 18. PB&J, you like peanut butter and jelly? I don't. I've never eaten one. I'll give you 10. I've never eaten.

I've had a bite. It's stupid American theme. Shut the hell up. Are you eating Vegemite? It's dirt on bread. Wow, Jack is very upset. You can't see Jack, Tom. with jam oh you eat Vegemite with cheese and it's dirt on bread wow Jack is very upset

Jack is you can't see Jack Tom he's off camera Jack is very fired up you don't know him but this is the most fired up he's ever been I think if someone

if I was offered a peanut butter and jelly sandwich as a child it would be something I ate but as an adult I can imagine what it's going to taste like I'm fine

peanut butter and honey no that's a great sandwich no I've had peanut butter sandwiches I think no we're going to taste like i'm fine peanut butter and honey no no no i've had peanut butter sandwiches i think no we're gonna make all right well this is on the patreon um okay tom so uh what is health insurance jim said yes it's like all insurance small amount you pay to guarantee if something bad happens it'll be covered i think that's pretty he got a 10 on that one that was perfect all forest and all trees

what was the first law passed in the united states in regards to health insurance yeah he yeah he said after a war actually that wasn't true it really was around the mid mid 1960s when medicare and medicaid started so we were quite late to the game. The first health insurance law was in Germany around 1890. But I think he was right in saying that in terms of universal health care coverage, the NHS in England was among the first, and that was around 1948. So in that respect, he was right. But the US didn't get to it until much much later and we still never reached universal coverage i meant to ask this to you too so before health insurance how what happened like if a doctor saw you like what jim what do you think he's paid for it i guess yeah i mean was it is it just was like a thing or yeah there's no magic to it you just paid for it if you didn't pay it you

might be able to get your church to pay for some charity care or you might more likely go without it. One interesting thing is that before 1965, half of people in the US over 65 had no health insurance. So it was a really big problem. Right. Wow. And they didn't even have GoFundMe back then, which is now healthcare. Yeah, you had to be religious. Yeah. Damn. When did health insurance, as we know it, first come into existence? Is this the same kind of answer, basically?

Yeah, this is the NHS one. No, it's a different answer. Oh, okay. See, that's what you learn out of chaplain documentaries. Basically, it started in the 1930s in the United States when hospital insurance formed in one of the blues, Blue Cross, and then in the 1940s, Blue Shield for physician coverage. So it goes back basically to around 1930. It's just that a lot of people didn't have it until fairly recently. So I imagine like if you went to war in the second world war,

where before we had universal healthcare anyway, I reckon that'd be a good way to get fewer of your ailments fixed. Yeah. The army would have taken care of you. It's like your joke used to do about, you couldn't afford health insurance. So you crashed your car and then you go, all right,

I got lupus. It must've happened with the airbag. Yeah. That's it. That was pretty close. That was the one have happened with the airbag. Yeah, that's it. That was pretty close. That was the one I did with Conan. Check it out, everybody. One of the government programs is the Veterans Administration.

That covers veterans, and they've had that for a long time. And it looks a lot like what you might think of as socialized medicine. You know, the government provides everything. So it's one example, and we'll talk later, I think, about socialized medicine. The U.S. So it's one example. And we'll talk later, I think, about socialized medicine. The US actually has some of it. And ironically, it's for former military people. I think part of the problem with trying to sell healthcare to Americans is the word socialism. A lot of Americans hear the word socialism and their brain goes straight to communism and they don't seem to be able to wrap their head around it and you know as someone who came from a socialist and right now

i'm going to get people going what happened to covid you were not there shut up you don't know what you're fucking talking about um but uh yeah socialism is a bit of a dirty word i think we need to change that word and we call it the govey government government givey program or something. You know what I mean? Govey gives. Yeah, yeah. And get some mascot who's like a panda that's dancing or something next to it, you know what I mean? So that we can soften it up. What are you doing with this with the money?

Yeah, yeah, yeah. The government's like this. Making it rain. Healthcare. Is socialized medicine a bad word, do you think? Yeah, socialized medicine is generally a bad word. We usually talk more about universal coverage. I mean, the UK system is probably the closest of the major Western countries to have it, and it's even not socialized medicine. For one reason that Jim mentioned, which is some people have private coverage to top off, but also technically the doctors don't work for the government.

But when you think of socialized medicine, it's sort of like the old USSR, which is the government owns everything and the government runs everything. And markets are involved in lots of aspects of healthcare systems, even in the UK. So it's probably not a very good term to use because it's not very accurate. Yeah, because the ones in Britain, well, the ones in Australia, it's like you can be like a doctor that gets the government money amount or if you think you're starting to excel as a doctor, you can go up and then you can be a doctor who takes private patients as well.

And so you can earn a bit more coin that way. So it's not restricting capitalism in any way. Right. Yeah. Why would a healthy young person want to spend their hard-earned money on health insurance? Well, I think that there are probably three reasons and Jim got the most important one by far, which is you don't want to go bankrupt. It's said that about two-thirds of personal bankruptcies are in part due to medical bills. That's the main thing. He said you can break a leg. You can be run over by a car while you're texting as you cross the street. You can get cancer. He mentioned that as well. That's the main reason. I think there are a couple of other reasons you might want to. One is to go to a better, higher quality, less crowded facility. If you don't have insurance, you're probably going

to have to go to a community health center. You're going to have to go to the emergency room in the hospital. You're probably, on average, not going to do as well if you have to do that. I would say the third reason to have health insurance is that if you don't have health insurance, you might get this ache or pain and say, oh, I just can't afford it. I'll live with it. It might be very dangerous. You might not be getting the cancer test you ought to be getting. So health insurance makes you feel more confident that you can afford preventive care. So that would be another reason.

And it's the same with car insurance. It's like when you take your car into a mechanic and you've had a fender bender and they go, they go, are you claiming this on insurance? And then you go, yeah. And they're always like trying to cut your deal. They're always like, all right, if you claim an insurance, I'll do this and we'll throw in that or whatever. Then if you're paying for it yourself or you're paying out of pocket,

all of a sudden the price is a third of what they're charging the insurance companies. Now, you always feel like, oh, a bargain. I'm getting it for cheaper or whatever like that. But these hike up our insurance policies and our no claim bonuses and all that type of stuff. Whenever I go to a doctor in America and I have a procedure, I find the only doctors who give you an honest price in America are plastic surgeons because they can never be covered by insurance. It's elective surgery. So they have to go. A set of tits costs 20 grand, eight grand, whatever it costs. That's what they cost. But sometimes you break your leg in America and all of a sudden they'll go, it's $40,000. And

they just give these out landish. And then you go, I can't pay that. And they go, okay, 15. He's outlandish. And then you go, I can't pay that. And they go, okay, 15? It's like it's just, shouldn't there be at least a government body that puts a price margin on how much procedures can cost? Or is that just, am I just talking rubbish? So that's what pretty much every other Western country does except the United States.

They have a fee, and the fees are known, and they're probably about a third of what they are in the United States. So it's not rubbish at all. It's just something politically we've never been able to do. One thing I want to say in your response is that it's kind of ironic, but it works a little bit the opposite of what you said in healthcare than it does in auto, which is if you have insurance, you're probably going to be paying about a third of how much the price is going to be about one third of what it would be if you're not insured. So because your insurance company cuts these deals with the insurance company, if you're uninsured and you go into the hospital, they have no incentive to deal with to cut you

a deal. And so ironically, it's the uninsured who face the higher rack rates and the insured people pay much less because of these deals, their insurance companies, uh, uh, cost. So the people can afford at least are the ones who are charged the most. Yeah. I, when I ruptured my Achilles, uh, I had no health insurance. I had nothing. And I went to see an orthopedist in, in Miami and they actually negotiated with the anesthesia. It was all outpatient anesthesiologist, the, the, the surgery place. And they negotiated all these prices for me. Otherwise I'd have been screwed. And it was like, I remember getting a bill from the anesthesiologist and it was like twelve thousand dollars and i was like what the and i just sent

it i called up the the orthopedist like oh we'll take care of that and then it was like oh it's like a grand now or two that was like what it's the same thing that's how this country's set up with so many it's like it's so expensive to be poor here and like you think of all those like payday loans and all that stuff it's just all predatory shit that that people that don't have money end up paying more and like when people talk about these rich ceos like we need to go to them to talk about money management i'm like i want to talk to the single mother of five kids who's somehow made things stretch because obviously they're much better at budgeting than fucking rich people i I'm angry about rich people. Calm down. Hey, rich people.

Tax the rich. I said, what type of health insurance? Leave them alone. They're doing their best. I said, what type of health insurance is in the United States? Jim said, private. But then I asked him about public. He said, Medicaid. He thinks I asked him the difference between Medicaid and Medicare. Maybe we can

talk about public, private, United States. They're the trees, man. I don't know if I'd call it the trees, but that was the one thing that he really got wrong. I'm afraid. Sorry, Jim, because you said that there's nothing good about public coverage and that's just simply not true at all. So there are actually more people have public coverage than private coverage in the US. all. So there are actually more people have public coverage than private coverage in the US. Well, that's not true. I'm sorry. It's about half and half. The public spends more. So there's Medicare, and that provides coverage for people 65 and over and the disabled population. And people love it. It's great coverage. That's what people didn't have before 1965. So when we turn 65, we all get free healthcare in America?

No, it's not free healthcare, but it pays for a large portion of the healthcare. And it's a very popular program that it's hard to imagine living without because older people have so many health problems. Now, the even bigger program in terms of number of people, it's almost a quarter of the U.S. population now, is Medicaid. And that provides coverage to people who are poor in most states, but not all states near poor. And that's a lifesaver. About half of births in the United States are covered by Medicaid now. So imagine if we didn't have Medicaid, we already have the highest infant mortality rate in the entire developed world. Imagine what it would be if we didn't have Medicaid.

Oh, yeah. I was thinking that the other day. I had a baby and they're not cheap to bring into the world. I was thinking, how do poor people fucking bring these things in? Yeah, and that's the big problem too with the abortion laws. It's like, okay, we don't have universal healthcare and you're forcing people to birth children that they can't afford and then wondering why crime increases or depression or suicide or any of those things, it's all related. Yeah, we should mention abortion. That'll really not split the room. That's part of healthcare.

So Medicaid is not the greatest thing in the world because it doesn't pay providers very much. It only covers poor and near poor people. However, it allows people to have a regular source of care. And it means they don't have to go through the emergency room for things. So it's something that I think we should feel pretty good about. It's just a shame that 12 states haven't taken up Obama's offer and covered a whole lot more people uh by met by um through the medicaid program and some of those states have a whole lot of people like florida and texas and georgia and north carolina so the people who live in those states really are screwed i'd be happy to change it to trump care it wouldn't bother me in the slightest call it whatever president you're

having at the time yeah what is that so i've's, you know, some people, like I know a lot of people that the Affordable Care Act has helped. We can jump ahead to Obama. And then there's people like, ah, it's ruining it. It's made prices go up or it's more expensive to have it. I mean, what's the controversy there? The only thing I've heard is I haven't been able to keep my doctor and I don't understand that either.

What's going on? Well, under the Affordable... First of all, the Affordable Care Act did not change most people's health insurance. People had employer coverage and people had Medicare, which is probably 80%. And people who already had Medicaid, which is probably 80% or more of the people, they didn't have any changes. What the Affordable Care Act did is people who didn't have those types of coverage now could get coverage more affordably. Basically, it was individual rather than group coverage that was

subsidized by the government. The subsidies now are pretty good. For an individual, they go up to about $75,000. You can get some sort of subsidy. It's on a sliding scale. For a family, almost up to $150,000 under Biden. So basically what the ACA did or Obamacare did is it made individual health insurance more affordable for people who didn't have it. And as a result, the uninsurance rate in the US, which is zero elsewhere, went from 18% to 10%. So it actually had a big impact. From what I can tell from the literature,

it didn't have any impact on prices. Okay. So it's just like propaganda. And so the people who don't like it, they're just anti-Obama? Is there anything else not to like about it? I don't really think so. So keep in mind that when the Republicans controlled the House of Representatives, they voted 50 times to abolish Obamacare. So it was a political thing. It was a Democrat versus Republican thing, basically. And it hasn't changed very much since then. Why would any Republican, I don't want to get into the Republicans bad,

Democrats good type of argument. Right. Why would anyone follow the Republicans if they were going to take their healthcare away? What was the scaremongering? What did they, what did they say? You know,

the scaremongering is basically everything government does is bad. So we want to don't want government more involved in health care. So the Republicans whole thing is this. Don't listen to us. You don't want anyone in charge. We'll do nothing. Well, and so much of the information that people get is from like Facebook or something like that. So they'll they'll see one anecdote where somebody is like, well, my bills were so much more expensive

and it's really just that person had heard somebody else say it. And then they changed the narrative a little bit. And then those things travel. And then all of a sudden you've got all these people going, well, it's so much more expensive than I used to pay. And like, nobody's shown a bill. Now, when you wrote the book and you ranked all the different health care, this is obviously, okay, so it's partly, I guess, your opinion, but what did you base your opinions on to make these rankings?

So what I did is I looked at about 70 different measures, I think it was, of outcomes and equity and access and made a subjective determination. And I didn't rank them 1 to 10 because I think that some are better in some ways than others. And we can talk about that as we go on. So the 10 countries I had, I can only remember them in alphabetical order, were Australia, Canada, France, Germany, Japan, the Netherlands, Sweden, Switzerland, the UK, and the US. And the US was by far the worst of the 10 countries. And if you also look at popularity, opinion polls, the Americans hate their healthcare system way more than other countries. If you ask them, should the system be completely dismantled and start from scratch, all the

other nine countries, less than 10% of the people said so. In the US, it was, I don't know, something like 30%. My two favorite of my 10 countries were Germany and the Netherlands. Interestingly, the government isn't that involved. You have sort of private nonprofit bodies. You have groups of insurers negotiating with groups of providers, groups of hospitals and doctors. Prices are lower. There are no waiting lists at all. Everybody's covered. Prices are manageable. So those happen to be my favorites. And we can talk about Australia and the UK as well. No, I always heard that the European countries were better than the Australia and the UK one.

France is, we did a thing on the Jim Jefferies show, the France, like, is it true that they give you an extra bed for your partner to sleep in when you're in hospital? I would not be surprised. I think they send doctors to your home.

They're they, when, you know, when you have a baby, they give you all sorts of financial resources. So France, France has a very good system as well. I'll give you an example that just happened to me, right? So I had a baby.

My baby was born premature, so it wasn't like the strongest of babies ever. We had two nights in the hospital, and then they send you home, good luck, right? My brother had a baby two months later. In Australia. In Australia. Full-size baby. Not a complication. Right.

They left after four nights and they could have stayed another two. Wow. Right. They could have stayed another two. But in America, it was like when you don't even get a late checkout. They're like, how do you get bloody midday yeah and if you look at the international data australia has really excellent outcomes uh health outcomes compared to most other countries so it does look really good there not when it comes to

skin cancer you're gonna have a bit of ozone layer we're fucked over here's one that i never this always confusing me since i've been alive what is there's a ppo hmo pos since he's been alive year one yeah since i was a little i came out of my mom's identity what does it ppo there there are only three that you really need to pay much attention to. Two of them are pretty obscure terms. But think of it this way. We're going to leave HSAs. I'll tell you what that means in a minute to the side. We'll talk about PPOs and HMOs, which Jim didn't know what they stood for. But if he is born in the US, he probably would have because they're pretty much part of the language. Now, PPO is a preferred provider organization.

HMO is a health maintenance organization. There are two big differences, okay? The big differences are, do you have to stay in the health insurer's network or can you go out of the network and pay extra? That's one difference. The other difference is, do you need a referral to go to a specialist? In an HMO, you have to stay in the network. You need a referral. In a PPO, you can go outside of the network, you pay more, and you can go directly to a specialist. You don't have to stay in the network. And then these other ones, EPO, POS, really is a term. They're sort of hybrids that are in between. The health savings account, the HSA, is important because I think a lot of young people have these in part because it's the only choice their employer gives them. And these are like personal checking accounts for your health care bills. And they're tax favored in a couple ways.

The first way is the part you pay is from pre-tax income. So you don't have to pay income tax, federal state income tax that. And the second is the money you accumulate in these tax in these accounts, the interest that you get, the growth is tax free. So they sound like really great things, but the rub is that they have to have a very high deductible. And a lot of people either don't want a high deductible, or if they have a high deductible, they'll avoid services that they ought to be getting.

But that's what an HSA is. Well, the deductible does my head in as well, because so often, like, I don't know medicine to medicine. Sometimes you get a medicine and you'll go down to your CVS and you'll go to get it and they'll go, this one's not covered by your insurance or it's partially covered by your insurance and you have to pay 20 something dollars on this or whatever. And there's always, even at the doctor's office, there's a $10 copay that goes along with the whatever. And they could say anything to me when I walk up to the counter.

I don't fucking know. Tell me it's $600. All right, I'll fucking pay. Now, when Kate, my ex, was pregnant with my son, we were touring the UK one time, right? And she was about seven months pregnant. And she had to have some root canal surgery. Like proper dentistry had to be done. And we were in Liverpool, I remember, right? And she was about seven months pregnant and she had to have some root canal surgery, like proper dentistry had to be done. And we were in Liverpool, I remember, right?

So we took her off to the doctor and then they looked, oh, you know, this is emergency root canal. We've got to go straight in there. They did the whole thing. I said, she came out and the girl behind the counter was like, so are you a UK citizen? Are you a resident? Are you fucking anything? I don't know and then and then she went no i'm from canada i'm just here for a couple of weeks and then they're like ah well we'll have they'll have to be a copay because you're not from around here right and we were like fuck they're gonna go for us here we're bloody tourists without insurance right and they go she goes 12.95 we were at 1,295 no 12 pound 95 and i was like laughing like really i would have to pay that with my insurance in america they'd find some

extra add-on for root canal that i own 50 bucks it's like so i i never understand why people who are traveling to the uk because the u because australia you have to the UK, because Australia, you have to be a citizen. I can't, you have to be a resident. I can't get healthcare in Australia right now because I'm not a resident of Australia. When I go back into my things, I have to get insurance. Right. But in, in, in Britain, why you would ever buy travel insurance to go to Britain? I would go there just to break my leg.

You'd go there and then break your leg. Yeah, break. Just break my leg. Cause that's the place. You just drag it in if I have a broken leg I get on the plane and then I fly over there I just got it at Heathrow and then they'll fucking fix it for you on the root canal thing is like dental care

is not even included in a lot of health insurance 12 pounds 13 pounds maybe this would be for you, but it's not true for everyone going to England. Theresa May, before she was prime minister,

when she was in parliament, said out loud on paper that she wanted to create a hostile environment for immigrants who wanted to come to the UK. So they were not given a very nice situation, immigrants who tried to come to the UK. So they were not given a very nice situation, immigrants who tried to come under the...

This is before Theresa May. This is me milking old Tony Blair. This is back in the day. He didn't give a fuck. So these co-pays and the paying 10% and all that, that actually happens in other countries, particularly for dental care and for prescription drugs. What's really unusual about the US and what stinks is how big our deductibles are.

You can have a policy with a $10,000 deductible. That means you have to pay $10,000 in a year before the insurance pays anything. No other country has anything resembling that. It's a uniquely American thing. Really, really big deductibles. Yeah, a lot of your insurance here is just like, you're just getting insurance for cancer. Mine's called the Catastrophic Plan.

Is it? Yeah. That's the name of it? Yeah, it's the Catastrophic Plan. It's an $ eight thousand dollar deductible this is what nugget productions offers yeah well jack stay safe i'm trying that is the technical name for it catastrophic plan the catastrophic plan and then there's people and you're talking about going to other countries i

know there's like medical tourism i because, cause there was a question there. I didn't ask, but dental insurance isn't even included in that insurance. I remember when you sign up, like, Oh, do you want dental too? Yeah,

of course I want dental. And then I know a lot of people that go to Mexico and get like dental. Jack, your, your insurance covers both. All right. WGA, the writer's guild insurance was awesome.

I don't have it anymore. So I had to go back to this LA care. Covered California. Covered California. And it's like, oh, good luck. And dental, it's like, I don't even have dental now. Yeah. A lot of countries don't actually have dental insurance.

In the U.S., most people have it, but it's very thin coverage. I'll give you my own example. And this is from a while back. My kids are in their 30s now. But when they were in their late single digits and early teens, they needed orthodontia. We had Delta Dental. Back then, so this is 25 years ago, I think the orthodontists are smart. They get you twice. They get you when you're about eight to make your jaw bigger. They put on these torture instruments to expand the jaw. And then they get you in the early teens to

give you braces. And I think that each costs like about $7,500. So we had to pay $15,000 per kid. The lifetime maximum per kid was $1,500. So in other words, my great Delta Denta paid about 10% of my kid's orthodontia. Yeah, no. i don't trust all dentists in like that man i just feel like i feel like every kind of meat now is getting visalign and all this type of stuff i feel like they just tell you something's wrong with your teeth they says me with my fake teeth jack had invisalign and his teeth are great now i had i had i had

braces when i was but all you know the other thing about dentists? They all think they're funny. Every dentist is always like, hey. They've got their hands in your mouth and they're asking you questions like a camera. I was going to be a comedian too. Laughing gas. Pretty much my health insurance plan is put everything

off until I'm rich enough to deal with it. But I'm still waiting on the get rich part. Yeah. That one's, that one's easy. My teeth are going to fall out. Yeah, for sure. Um,

okay. Oh, American medical association, AMA. What is their role in, in shaping us healthcare? Like, what is that?

What are they about? What are they about? Yeah. So Jim was sort of, uh, kind of the opposite of right on that one, which is they don't really police health insurance. The AMA represents doctors, but there's a couple of things there. First of all,

it used to be about half the doctors were in the AMA. I just looked it up and only about 15% are now because the rest of them either don't believe in the AMA or they don't want to pay the dues. And the AMA historically has called any government in the 40s, they were the ones who called Truman, Harry Truman's plan for national health insurance, socialized medicine. And they attacked Medicare in the 1960s, tried not to make it happen. So they've always been pretty right wing in their viewpoints. Well, anyway, it turns out they made out like bandits with Medicare because they weren't going to support it unless they got a good deal. They got a great deal. They became pretty rich off Medicare. And now they I think they they kind of like it. But they traditionally been a very conservative,

They kind of like it, but they traditionally been a very conservative, politically active lobbying organization. So that's that's what they look like in a lot of. So I'm at a university at UCLA and a lot of the physicians at UCLA believe in national health insurance. And they're in like a different medical group, the Physicians for National Health Plan. So there are various competing groups, the African-American physicians of many of them joined a different a different medical group so the ama doesn't in any way represent all physicians but they certainly get the most visibility and they have a famous journal called jam of the journal the american medical association that gets on the news some but um anyway that's what the ama is one of those things that you think would be like all right we want everyone to be and it seems like they're always jamming it up more than like the

front league you said jam i just said but they're always mucking it up um muck's also a good journal muck journal uh um here's two questions that are kind of what percentage of americans have health insurance and then like what percentage of americans believe the government should i said 70 percent but you said 70 have and 50 of americans think the government should provide it well that would be pretty grim if it were 70 uh before obamacare was 82 now it's 90 so uh nine out of ten people but you know pretty much everybody has it in other countries in terms of the percentage of people who think that it government should make sure everyone has coverage, Jim said 50.

He was close. It was 60% of Americans say they think government makes sure everybody has coverage. But you can't bring it up. If you bring it up, people get very, very angry. I know. It's so weird. People get very angry if you bring up just the concept. Like Bernie Sanders talked about it all the time and uh people thought he was a communist yeah and i had i had a friend who is he's republican

and he and he was like he was just like against any what you would you know the term socialized medicine but universal health care or something like that and then he had a very close friend that got sick didn't have health insurance and then then they started to GoFundMe, and I'm like, eh, eh, there's a solution here. That's the problem. People don't care unless it affects them. Yeah, yeah. Well, my friend, Dr. Drew, who's a famous doctor, he told me that socialized medical care never works in any other country

and America's got the greatest system on earth. It's part of the AMA. He's one of my favorite people, man, and I was just like, ah, dude. Come on. I can't. I favourite people, man, and I was just like, oh, dude. Come on. I can't. I can't, but that's his way. His brain's wired about this particular subject. So everything's conditioning.

It's what you grow up with. Where did Australia come on that chart? I can't imagine it was number one because Australians bitch about their medical healthcare in Australia as well. The British are dead proud of the NHS. They're always carrying on about how good it is. But then also, this is a card that the British do, right? Because they're all paying money into the healthcare like this,

they'll do things like every smoker costs the NHS 50,000 pounds in their lifetime. So it turns the public against you as a smoker because they're just like, you're costing me money. The taxes like that, right, which they never mention. Every smoker spends $120,000 in extra taxes in a lifetime because of what the government put on cigarettes. Like they pay for their cancer.

Leave them alone. But so there's a lot of that. But the Australians do this whole, oh, this bloody medical fucking bloody medical fucking thing is country stuffed Australians are big fans are saying the country is stuffed and then saying afterwards but it's the best place on earth right that's like there was a sketch in a tv show back in the day they used to do that's a real Australian thing this place sucks you wouldn't want to live anywhere else um so where did Australia rank in that well so actually it was interesting you said that that the australians are complaining more about the brits so i was looking at my book and it has a

table about uh how many people think the system works pretty well uh and doesn't only needs minor changes both australia and the uk were 44 so people seemed about equally happy with the systems in the two countries australia ranks really good in people keeping people happy happy with the systems in the two countries. Australia ranks really good in keeping people happy. The way in which Australia looks worse than the UK is it's a much less equitable system. And the reason it's more equitable, you kind of mentioned earlier, which you can top off things with private insurance. In the UK, only about 3% of people top off or 5% top off. In Australia, 50% do. The people who get private insurance, half the people, half the population, they wait half as long to get procedures as the people who don't get the private insurance. So

Australia is less equitable. Plus, they also have the Aboriginal problem as well. Australia is less equitable. Plus they also have the Aboriginal problem as well. Yeah, yeah. Well, that's a whole other podcast that we're not willing to do. There can be some other podcast. I don't want to get involved. There's a few things that people think that with the Aboriginals who live in rural areas, then it wouldn't be cheaper just to move them

into suburban areas because they have to fly out planes with doctors and nurses and stuff and the taxpayer pays for that and by the time they pay for that we could just house them for half the price, right? And so, and then as the Prime Minister he said, if these people want to live this lifestyle he called Indigenous Aboriginals living on the land a lifestyle choice, right? So that was a bit of a, you know, a bad sort of foot forward. Don't get me started on the gay Aboriginals Living on the Land a Lifestyle Choice. So that was a bit of a bad sort of foot forward. Don't get me started on the gay aboriginals. Yeah, so that's a very delicate.

I understand both arguments a little bit on that one as well because it's like, why are we spending so much money? But anyway, we're not going to get into that. Why don't we talk about someone who changed the subject real quick. What countries have similar systems to the United States? Jim said he doesn't think anyone does. Maybe someone in South America. Yeah, he is right.

So the reason that we're an outlier in two ways. One is we don't offer universal coverage. The other is we spend way, way, way, way more than other countries. Even though our outcomes are worse, our access is worse. So those are ways in which we're different. But if you want to talk about countries that bear some resemblance to the US, as I mentioned, Germany, the Netherlands, and Switzerland, they all have a lot of private insurance. But the key difference is that they're not for profit. So basically, the role of their insurers is to pay

bills. What are our private insurers do? Well, they're owned by corporations, corporations owned by shareholders. And so the motivation, we learned this in basic economics, is to maximize shareholder returns. And so what, you know, an insurer is really motivated to do here is to, you know, maybe not pay bills. And so that makes the US really different than other countries. There's just a much greater corporate... It's not that corporations aren't involved in medicine in other countries. Corporations aren't involved in health insurance in the other countries. What they do is that private insurance is involved in the wraparound. They're not involved in the core insurance.

And I think that might be the thing that really makes the United States unique. When you said those companies are non-profit in Germany, in the Netherlands, so who owns those companies? Is it just somebody charitable who just wants to help everyone out? Or are they government-owned private? So how are they?

So they actually, you wondered how far health insurance, Forrest asked how far health insurance goes back. Well, it actually goes back to the Middle Ages in a way. It's the guild system. So these were basically workers' guilds that tried to provide some support. It goes way back to when a guild of workers wanted to provide support for, say, a widow whose husband died on the job. And these formed through these sort of nonprofit groups. And so employers were involved. So it was really more of a consortium from the employers and the employees and now the nonprofit companies. So for-profit was never involved in this.

It was more something that was on the job that became institutionalized as their national health insurance programs. No, but of course they could turn a profit, right? They might not be for-profit, but if they get enough premiums coming in and people have a healthy year, you know, maybe COVID is a down year for them, but what happens if there's a surplus of money that is just staying in the company to make the company better? It depends on the country, but I think that what would happen in a country like Germany is that they would then lower the part

of your paycheck that you have to pay each paycheck for health insurance because I know that they have to raise that part of the paycheck. Boris just reeled back in shock. So basically the goal in a place like Germany is to try to control healthcare costs so people don't have to pay more out of their paychecks to pay for health insurance. And so Americans spend how much? That wasn't Hitler who brought that in by any chance, was it? out of their paychecks to pay for health insurance. Wow. Yeah. And so Americans spend how much? That wasn't Hitler who brought that in by any chance, was it?

So I don't want to talk about that. On average. Or like how much do Americans spend on health care each year? Jim said each person spends around 10 grand. Yeah, he was close. It's about 12 5 12 500 but younger people pay way way less and older people pay way way more but americans spend on average about twice as much as your typical uh western european country about you know twice as

much as canada so way way more here and then um these were some of the things like an ambulance ride he says was like 5,000. I didn't ask you how much an MRI or a bag of ice in a hospital is. I'm about to get an MRI on my shoulder tomorrow. How much is an MRI? I don't know. I reckon an MRI is going to cost me three grand just to fucking be in the machine. Yeah, I don't know.

I think I looked it up and the average is about $1,250, but it varies from hospital to hospital. So it actually helps to shop around for that sort of thing because your insurance may not pay for the really expensive ones. And that's like, you shouldn't have to shop around. You're already worried about being sick. I've got a coupon here for my MRI. Well, that's it. You asked the cost of an ambulance and there's so many people in this country that will turn down an ambulance ride when they really need one because they're like, I can't afford that.

What price is it? I've heard that they're around like a thousand, but I don't know. Is that correct? Yeah, I looked it up and it looked like a typical average varies between 500 and 1200. I think it depends crucially on whether it's a private firm that runs the ambulance company or whether it's like, you know, your fire department. Right. And the charge master, we've kind of touched on that a little bit. Jim said the bloke in the front there, he yells charge. That couldn't have been right. Yeah, he didn't quite know that. But that's all right. It's a a list of thousands, if not tens of thousands, of rack rates that a hospital claims that charges, but it only charges that much to uninsured people.

It charges less to uninsured people. What the fuck? I'm depressed. Why do they do that? What is the benefit of doing that to the uninsured? The benefit of doing that is to try to maximize profits. Yeah. I know, but why don't they maximize it with the insured? Because the insurance companies don't put up with that shit, I guess. The insurance companies have bargaining power. They don't put up with that. Well, let me ask you this then.

The undercoding. What is that? It's under the code. We've gone through most of these, I think all the questions that we asked here, but do you think your personal opinion do you think in the united states we will come to a we'll move up those ranks that you did or we'll come up with a system that's closer to something in england or australia or any or germany like where it's you know what do you think have they ever given universal health healthcare a go here? Has there been like, or is Obamacare the closest? Obamacare is the closest.

That's exactly right. And I think what Forrest was saying, do you think we'll ever give it a go? No, I don't, not for a long time. I think that, you know, we had, Obamacare was a good opportunity. We cut the uninsured rate about in half. I think we might make more progress on getting more people covered. But in terms of controlling costs,

I don't really see tremendous progress being made there. For example, in Biden's efforts to try to deal with a prescription drug cost that was dropped from the bill, the bill that Joe Manchin just killed, that wasn't even in the bill because politically they couldn't have that. Dental insurance was supposed to be in that under Medicare. That was dropped from the bill several weeks ago because politically they couldn't get there. I think politically it's going to be very hard to do anything that cuts costs because the way to think about it is, and I didn't make this up, that a dollar of cost savings is a dollar of somebody's profits. So, you know, it's really hard the way we have our political system here to try to cut costs because you're cutting profits

and there are an awful lot of special interest groups there. So I think that we will make better progress on coverage eventually. I don't know about costs. One think that we will make better progress on coverage eventually. I don't know about cost. One thing that we're making good progress on is delivery of care. I think we're providing better care. And yeah, I think that we'll probably improve in the ranking somewhat, but it's going to take a long time because we're so far behind a lot of other countries in treating curable illnesses. Is there a third option? I remember Mark Cuban told me when I interviewed him, he said something about like- A lot of name dropping today.

No, that was on the TV show, Mark Cuban, because I said, what would he do about healthcare if he became president? He said something about you would put money into a thing and that would be a pot of money and then your surgery would come out of that and the pot of money would rise up and if you went over, you could have a payment plan so that everyone's sort of still paying for their healthcare but as they need it.

Is that like an HSA? It sounds like an HSA, but what Jim's describing sounds like something that's not an individual account but that there's some sort of collective aspect to it. And I'm not aware of Cuban's proposal in that regard. Look, I might be getting it wrong. But I used to work for the county government in Florida and Dade County. And I remember they were self-insurers, what they would call us when we were driving our cars. So anything like they would they would put money each month into this pot. And if someone got into an accident, they would that's how they would call it when we were driving our cars. So anything like they would put money each month into this pot

and if someone got into an accident, that's how they would do the insurance. So maybe it's something like that. Because the theory is with insurance that most people pay more for their premiums than they do for their medical care and their lifetime. It's the same as cars. Otherwise, these companies would cease to be companies if they weren't turning a profit.

Is it sensible of a person to back themselves and go, all right, rather than give $1,000 a month to this company, I'm going to put $1,000 in a bank and then I'm just going to take my medical care out of this bank account that I keep putting it into and hope that I have a good five years where I don't get sick and then on it's all just gravy. Am I talking lunacy right now? And then on, it's all just gravy. Am I talking lunacy right now? It's putting a lot of people in great jeopardy if you were to have everyone on an individual account. So I would like the way you defined insurance that everybody pays in and you draw it if you need it.

You need certain safeguards. You have to charge them something in order for them not to overutilize, perhaps. But the idea of individualizing things. Let me give you an example of where it works, the collectivizing. You get Social Security. You pay all this money in when you're younger and working. When you retire, you have a pension. And that's a great way to think about health care.

That's how Medicare works. You're paying part of your paycheck to Medicare. You have this benefit when you retire. And, you know, many people, including Bernie Sanders, believe that's what we should be doing for everyone,

not just for people over 65. Now, this is off the topic. Is there a government pension in America? There is. Social security is what it's all about. But isn't social security going away? Isn't that a risk of violence? sorry security that you pay into is there just a government amount of money like my father lives on a pension that the government gives him a

certain amount of money each week for just being old it's nothing that he's paid into he's so he's money that he's paying that's what social security in the end that you'll get no but he's still got his money that he paid in so so you could be unemployed your whole life and you'll still get the pension when you hit 65. Yeah, we don't do it quite that way. You generally need to work about 10 years to get regular Social Security benefits. But basically that's or you need to be related to someone like the like like the person keeping the house while the uh the bread earner does that uh that social security so it's a little bit different than what you described it's an incredibly popular program and it's the thing that keeps seniors out of poverty

you know most most people just don't have any savings what do americans get what is what is the pension what do you get i know what it is in Australia. No idea. It depends on your income. So a poor person who contributes less doesn't make as much as a richer person, but in a sense, they get a better return on their deal, return on their investment. But I wish I knew that. Maybe the average person would get maybe $30,000 a year in social security. I'm going to get a pension when,

but from my TV work, because I paid into something and I figured out that it's basically enough to my pension, basically enough to pay my medical bills. But now that I know when I'm 65, I don't have them anymore. Woo hoo. I'll be going up to getting up to no good.

Yeah. You'll have some money. That's what, to no good. Yeah, you'll have some. Free money. That's what Tom was saying. Medicaid doesn't pay for everything, but it... Medicare. No, Medicare is older. Yeah, I'm sorry.

Medicare is older. See, I always get it confused, too. Okay. I had some other opinions I was going to say about stuff. It was just me getting angry about stuff about the hospital and people that have cancer. I'll tell you the worst, pet insurance. Fuck me. I have pet insurance on Arnie.

Yeah, how much do you pay for that one? $500 a year, but I've already gotten it back. That seems like a lot. I've already gotten it back. I've gotten about $480 back this year. It was last year, I guess, because it's come. But still, it was worth it because I got reimbursed. It's not the way to think about insurance. The idea of insurance isn't

to make money. It's what Jim said in the beginning. It's protect you. In this case, if your pet has something really horrible happen to it. It's probably not the right mindset to have. I do have it because of something drastic. I've had animals in the past and then

you get there and they're like, this is $5,000 and you're like, well, you're like well i guess i'm killing them that's the reason that pet insurance do that joke it's like it's how many years has your pet been alive divided by how many times they've taken a shit on your pillow and times a hundred and that's how much money you spend on them so well i always think like veterinarians there must be for people who really really care for animals or for people who really fucking hate animals because i reckon you'd be putting it well how many animals you kill in a week oh yeah like it wouldn't be like i saw a lovely dog last night at work honey dead

they couldn't afford the bill yeah I do it because I love animals. Dead. This is the time of the podcast called Dinner Party Facts. We ask our expert guests to give us some sort of fact, obscure, interesting about the topic, this being health insurance, that they can use to impress people if they're at a dinner party or a bar or something like that. I know you said, when I asked you about this yesterday,

you said you made some sort of knock on health insurance, like you wouldn't be having fun. Can I have the 1 to 10 ranks before we start? Can I have the 1 to 10? The countries? Yeah, because you said Germany. Oh, I see what you're saying. I don't really want to rank them that way, but my favorite were the Netherlands and Germany of the 10 that I studied. The US was my least favorite. Australia, the only problem I have with Australia is that it's somewhat inequitable.

Did Australia beat the UK? Where did the UK come? So Australia beats the UK in terms of health outcomes. The UK beats Australia in terms of fairness. And so it depends on how you balance those. And Canada came pretty low because they had... beats Australia in terms of fairness. And so it depends on how you balance those. Okay. And Canada came pretty low because they had... No, Canada doesn't do so great

compared to a lot of the other countries for reasons I don't know if we have to get into, have time to get into the whole thing. They had the long waiting list and stuff like that. I think America is slightly hampered by their nearest neighbor having universal healthcare being Canada. Cause I don't know if Canada is the best representation. They do have,

they do have long waiting lists there. They don't cover prescription drugs, unlike the other universal health countries. And they haven't been very innovative in terms of reorganizing healthcare. So, so Canada doesn't rank so high in their medicine is just strapping a hockey leg next to the limb that you broke. I thought it was rub a little poutine on it. Got cancer, put a little poutine on there.

So do you have a dinner party fact? I do, but I think it'd be more fun if I made it a quiz for the three of you. Oh, sure. I'm happy about that. So here's the scenario. Okay. You're a mother of two children and you live in Texas. What's my body look like? You've had two kids. Am I hot like the stretch marks?

If I look in the mirror, am I happy with what I see? Your kids and your kids have Medicaid, but we're talking about you, the mother. Okay. So how much money a year do you have to make for Texas to say, oh, you're too rich to get Medicaid? Oh, okay. So you've got two kids and they've already got it and you want to have it as

well. I'm going to say 23,000. No, no, it'd be higher than that. Because that's, that's, I'm going to, I'm going to say 38,000. Yeah. I'm going to say 30,000. It's, I'm going to say $30,000. It's $3,700. Get the fuck out of here!

Wait, $3,700? Yes, it's 17% Is that a paper route? It's the 17% of the poverty level. And so if the poverty level for a family of three, I don't remember, it's something like $20,000. 17% of that. This is so depressing. No wonder they banned abortions. family of three i don't remember it's something like uh you know twenty thousand dollars seventeen

percent of that this is so no wonder they banned abortions who can afford them if you make four thousand dollars you're too rich you're you're too rich to get it this is texas one of the 12 states that hasn't expanded medicaid if they had expanded medicaid if I'm just, she could make probably about $30,000. If she made less than $30,000, she could get it. So that's Texas for you. So what medical insurance can that woman get for $3,000 something? Can she get anything? No.

Nothing. No, there's no way. She goes to the community clinic. Fun. I thought that would be sort of a downer way. For a bad dinner party. No, it's good. All of them are upbeat.

I mean, it's actually, that's a good talking point, really, if you're trying to convince somebody that universal health care is a good thing. I mean, that's a great talking point. And it's the Texas legislators and governors are the ones who are keeping this mother from getting the coverage that's surprising because texas normally loves taking care of its

citizens so especially the women yeah especially the women's um all right tom rice thank you for being here the book is called health insurance systems and international comparison um thank you for being on the podcast yes thank you thank you so much. We had a blast, man. I enjoyed that. Okay, thanks so much. To all the people listening to the podcast, if you're ever at a dinner party and someone goes, you know, American healthcare, just go, look, I can't fucking

talk about this and walk away. Good night, Australia.