Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Health Insurance

Episode Date: January 27, 2017

The American health insurance system is unlike any other in the world, and not in the good way. It's probably about to get worse. This is the story of how we got here. Music: "Medicines" by The Taxpayers

Saubones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, time is about to books. One, two, one, two, three, four. We came across a pharmacy with a toy and that's lost it out. We were shot through the broken glass and had ourselves a look around.

Some medicines, some medicines that escalate my cop for the mouth. Wow. Hello everybody and welcome to Saw Bones, a Marital Tour of Misguided Medicine. I'm your co-host Justin McElroy. And I'm Sydney McElroy. I am on an upswing for my, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in, in I mean, I guess. Are you, but Sydney, my lovely co-hosts here? I'm not. Well, I'm getting better.

I am also getting better, but as you can tell, I sound like you did last week. Yeah. Charlie keeps complaining because she says I have a man voice and not a mommy voice. So, said, this week, we wanted to talk about something that is on a lot of people's radar, currently. That's right, Justin. I want to talk about health insurance.

Nobody ever wants to talk about health insurance. I don't think, I mean, we are forced to offer... You don't literally want to talk about health insurance. I love to talk about health insurance. I want to, let me clarify, I do. Most people I think feel like they have to because of circumstances, because of the current situation, but I don't think anybody thinks, you know what, I really just want to go out with my friends Friday night,

hit the town, get a few drinks, and just talk about health insurance. Nobody likes insurance because it's an acknowledgement of the fact that calamity could occur. Exactly. And nobody likes to dwell on that. No, we want to live in the now. But we need to talk about health insurance. It's important because things are changing as they have repeatedly over history.

So let's get into that. All right, let's do it. Several people recommended this topic. Beth, Shabon, Josh, and Julie, so thank you. I think this is especially relevant. Hopefully this will also be a little bit helpful. Now, it probably wouldn't surprise you to learn that doctors have been getting paid for their services for a really long time. Like many traits people. Exactly. Well, you say tradespeople. That's actually one of the things we'll get into is whether or not medicine is a trade. Okay. But let's start back in the code of homorabi, there are references to various costs associated with different medical procedures.

So we see kind of like a priceless even back then. And it's funny because there's this one specific section that's all about the different costs for a physician treating you with a metal knife. Now, I mean, I get, the metal knife seems to be the important part of the treatment, not so much what they're doing with it. So like, are they cutting out a tumor? Are they cutting open an abscess?

Are they doing something to your eye? I don't know, the metal knife is the key. Either way, the cost is stratified based on your station in society. Well, they didn't know what the, you have a metal knife. That's gonna cost you extra because they had invented metal knives

but they haven't been in ways to sharpen them. So you could try it, like listen for mental life. Now if you want to use, I could do a clay knife. My friend Jerry makes a knife out of straw. I could use that for discount rate, but like, I need my good stuff on you. It's gonna cost me. It's gonna cost.

Well, and it really is only gonna cost more if you, sort of if you could pay more. So if you were in a higher societal strata, you paid more for the treatment. And if you were like a plebeian son, you would pay less. Sounds good. Yeah. I'll live roles. It sounds good to me. Yeah. So the less power you have in society, the cheaper the treatment is, although, and that sounds good, although what it also is reflecting is, was this belief that the service you're providing is not as valuable?

Like if you fix a king, you've done a great thing for society, but if you fix a plebeian son, you haven't really helped us that much. I mean, like that's, so it sounds nice on the surface. I don't know that it actually is nice. In ancient Mesopotamia, you would get, as a doctor, you would get paid more if you were doing a delivery, if you were delivering

a baby and the child was male. Oh, yeah. Well, you guys have a lot of input in there, right? Right, because we have so much to do with that. It's a special way you turn it. If you turn it wrong, you'll break it off. You gotta turn it right, you'll break it clean off. It's a little, it's a twist and then a yank.

It's funny because that offends me, but that's a doctor and a woman. So two levels, two level. The ancient Greeks and the Romans argued about just kind of what you were talking about, Justin, is medicine. They actually talked about is it an art versus a craft, which I think when I say craft, it'd probably be similar to what you're saying. Well, no. Hopefully not.

Although, you know, you could make the argument that historically there were lots of people who kind of just... There were a lot of hobbyists. Medicine was there. They're hobby. No, but the argument on whether it was an art or a craft, and I think you could use a word trade in place of craft in this context, was that an art was something that you did for the sake of it, that you did because you were compelled to do it. You knew no other way. This is what you

must do. You are driven to do it. And for an art, you could not take money in this Greek concept. You would never take money for your art. That would be insulting to what you do and what you are filled, you know, the drive you're filled with. But for a craft or a trade, if you make things for people for purposes, you know, if you're a leather worker or, I don't know, a metal worker, metal largest blacksmith. A blacksmith, there you go. And then you would get paid for that. That was a craft or a trade.

So there was a lot of argument with hypotheses and some of the other great medical thinkers. Should we take money for this? And everybody kind of- And the one doctor in the group's, yes, I think that we should. Dr. Shudder think. It was, and it's funny because they all waffled,

probably because they kind of wanted to get paid. Did they invent waffles too? The one that I know. I have no idea who invented waffles. I actually can't give you that piece of information. Okay. Well, next week, next week, you can tell me who invented waffles. Okay. I'm assuming Leslie Nope. Probably the Belgians, right? Um, Galen said that he was, he was pretty firm on this that physicians practice medicine, either because they love humanity or because they love humanity or because they love

honor or because they love glory or because they love money. Now it was preferable to Galen that you practice medicine because you love humanity. But if you practice it for any of those other reasons, it doesn't necessarily make you an inferior physician. You're just an inferior philosopher. That's a very black and white. Like, can't you love all those things? That's all good. That's a good one. I like glory people.

I'm into all of it for sure. Get Galen, no, he felt that if you practiced for the love of humanity, then you were a better philosopher. But you might still be a good doctor if you just practiced because you loved money. For the record, Galen would only take money if it was offered. So he would hit.

Oh boy, would he hit? Is there anything else you'll forget, I mean before, so you got your shoes, your coat. You just kind of stand there, hinting like the guy who brings your car around or helps you carry your luggage to your room or whatever, just kind of stand there and hinting like the guy who brings your car around or helps you carry your luggage to your room or whatever, just kind of stand there.

Just rubbing his fingers down like Rob Schneider and I hope I'm lucky too. It's funny because there's a reference and there clearly were there were doctors who asked for payment because there's a reference in the Canterbury Tales to how much doctors love gold. So this idea that doctors love money, while this sounds like this beautiful academic like, oh, we would never take money for our art, there were obviously doctors who were fine with it.

You begin to see this kind of idea though that because it is something that's necessary for survival, you know, providing medical care, that you should stratify how much you charge people kind of based on what they can pay. And so you see some medieval Islamic writings that reference that the rich, the rich should pay the physician more than enough because he cannot charge the poor. So kind of like let's, if you have the means, give your doctor more money than you really feel the service was worth, because there's going to be someone down the line who will not

be able to pay him at all, and a good doctor would not ask for money from someone who could not pay. So you're subsidizing poor people. It's an interesting concept. Let's see if that sticks with us. And in Europe, in the 17th and 18th century, we see some similar ideas. A doctor would either take just like you would basically charge your patient for the travel to their house

for the time, like if they had to stop and get food on the way or whatever, basically just kind of your travel expenses, or you could even have, and you would only do that again for someone who had the means, or you could have like a physician on retainer where you would pay a yearly fee and have a docket your back and call. And in return, the physician would take care of all kids and people who were living in poverty for free. So rich people, again, pay the physician for the community so that the community gets their services. That has some sketchier connotations to me. Like, I'm not sure I want the one rich guy in town to own the doctor.

Like Richard Pryor at the toy. Like, he'll only come by if you like, mind your peas and cues and. Well, and obviously that's very problematic because you are giving people who have money control over, I mean, I hate to think of myself as a limited resource, but it's certainly at the time a physician would have been a limited resource.

And obviously if there's a sick kid in the community, but the Baron or whatever has a hemorrhoid, the Baron's hemorrhoid is probably gonna get prefrontal treatment. Right, and he's gonna use the metal knife. The knife, the metal knife. There were also situations that were a little more charitable. There were churches that would pay for local physicians

to be part of the community and provide care to everyone in the community. And you see one example in Venice of the government paying physicians to take care of the people of Venice and even then to kind of be involved in early health policy and like public health matters to advise them on On what they could do and what was safe and what was healthy. So you see this kind of concept of a government sponsored healthcare System so to speak. I mean obviously a very loose association of one

now As we kind of move over to the US because because as we move into closer and closer modern times, I'm really going to focus this on health insurance and the history of how it arrived to today in the US. Obviously, our system is very different from many other systems in the world and many other developed nations. You can even say all industrialized nations.

Yeah, you could even say all. You might say that Justin and you would be right. So, I don't know, I'm not gonna cover the history of how all of the other healthcare systems arrived. So I'm sorry, but if you don't live in the US, this might be even more interesting to you. In 1780, the Boston Medical Society, obviously we're in the US now,

set minimal fee limits to prevent doctors from undercutting each other. So there was this because the requirements for becoming a doctor were still fairly loose, especially in the early days of US history, it didn't take a lot to say you were a doctor. There wasn't a lot of oversight. You would have these traveling doctors who would do things for very little money and maybe undercut other actual trained physicians who were trying to make a living being a doctor. They just a guy falling around at a real doctor. I'll take it off for

35. I'll get that leg off there. No problem. That's exactly the kind of thing they were protecting. So they actually set like lower lower price limits. So it's price fixing is what it is. So nobody could charge less than this. You could make your costs higher as economic, you know, as like financial situations got better. So with inflation, you could increase your prices, but you could not go below these lower limits. And they charged visits for visits when stuff wasn't done, which was a novel idea at the time. There were a lot of patients who, if you went to your doctor, got a checkup and your doctor said, looks like you're doing good, you don't need any medicine, you don't need any surgery, you know, I'll see you in a year or whatever. A patient wouldn't pay

because they felt like, well, you didn't do anything for me. I'm not going to pay you unless you do something for me. Yeah, that makes sense. Which was bad, one, for the doctor, and two, for patients because that also led doctors to maybe do and give out medicines and things that were necessary. This was the first time where you see doctors saying, no, we're charging you for our assessment, for our opinion, for our medical expertise, sometimes that results in a procedure or medicine, sometimes it doesn't, and both are valuable.

And you start to see this idea. The problem with this is that as different groups in different states, as they develop throughout the country, did this, you saw fees very wildly. So in Boston at the time, it would cost $40 to have your leg amputated. Whereas in South Carolina, you could get it done for $5. And part of that too was because any place where you saw physicians setting the prices, unfortunately, it was way more expensive. Not so great for our history, where you see governments or people kind of collectively dictating what they would pay.

You see a lot cheaper prices. And as physicians moved out west, as we began to expand out to the western frontier, you see costs go from money to you can pay me in chickens, you can pay me in goods, you can pay me in fixing my barn That kind of thing you see almost like a just a bartering system anything goes Now as we're moving into Modern times here's a good reference point By the year 1900 the average American

Spent five dollars a year on health care. What's that in modern day money? $100. Hotchy, won't you? $100 a year was what the average American was spending for all of their health care needs. Visits to their physician, medicines, whatever. $100 a year.

Okay, that's a bit of a species comparison though, because it was 1900 and nobody had any idea of how to do anything. That is a great point, Justin. It was all made up and it was all fake. It was all made up, well not at all, but a lot of it was. It was largely made up.

And you had no idea what wasn't made up is the biggest point. Well yeah, right. Because medicine wasn't tightly regulated, you could, everybody could sell whatever they wanted for as cheap as they wanted to, because it was just, it was basically a free market. You sold it just like you did anything else,

you know, your latest hair tonic or whatever. You just sold your medicine. And I mean, we've talked about before, and medicine shows you could give it out for free. Here's my medicine for free, and then I'm gonna give it to the local pharmacy and you're going to keep buying it from the local pharmacy because you like it so much. And because it has cocaine in it. Yeah, because it has cocaine or opium or a lot of alcohol.

So you would basically just go by the cheapest med with the most outrageous claims and most of the time you got better because you know, most of the time it's probably just a virus anyway. With the creation of the FDA in the early 1900s and the regulation of medications and as well as the way that we started to regulate training of physicians and who could say there were a doctor and what a doctor could do. We start to figure out what works, continue to do that, improve upon it, and do away with the stuff that's just plain fake. Now with that, you start to see things get a little more expensive because for one, fewer people are providing it. So you get rid of the lower end of the price spectrum, people who were just making stuff

up. And you're, as you concentrate more on actual doctors, you start to see things get a little more expensive and you're decreasing competition, of course. And patients were also getting saviour. They began to learn that, you know what, there is some stuff that actually works and some of this stuff isn't real. And I'm willing to pay for something that really works. And so, that also drives prices up a little bit as well.

Hospitals wanted to get in on all this evidence-based action, because at this point in history, hospitals in the US were basically really scary places where people went to die. Sure. That was it. The bad look. Yes, you didn't want to be in hospital. If you were in a hospital, I mean, hospital one turned that brand around. Exactly.

Because that was not very profitable for them. Right. So with all this new evidence-based medicine, they wanted to kind of rebrand hospitals as these positive, happy places where very smart science-based doctors worked and you could come get the latest treatments and medicines and get better. It's so interesting to think of those ideas as separate now, isn't it? You think of that, I don't know, the two are just kind of inexstricable in my mind that the doctor is at the hospital and I'm obviously a hospital's had doctors, I'm assuming, right? Oh, sure.

Well, I mean, hospitals had doctors, but it was really, you wouldn't go to a hospital's had doctors. I'm assuming right? Oh sure well I mean hospitals had doctors but it was really you wouldn't go to a hospital unless you were just so sick that your family dragged you in. They're going we think they're dying we don't know what to do. You would never think I'm getting sick. I think I should go to a hospital. Yeah. That wouldn't occur to you up until this point in history. One really important tactic in this and this could be a whole show onto it. So actually, I think we've done this before, is the concept appears at this point in history that you should give birth in a hospital. And when you start associating hospitals with a place to bring new life into the world,

that really rebrands them. Yeah. This helped hospitals. Not far if they didn't have any idea what to do. I mean, they put the heart for the horse on that one. The pregnant ladies would come in, they would just be like, I don't know, push. I know.

Listen, we're really interested in the marketing of this. Like, please tell your friends, like, we have nothing to do to help you. But we kept all your midwives out and they really know how to do this. And we're not quite sure. And there's probably a big mistake. Do you want us to put you to sleep?

Because we could do that. Do you want to sleep through this? Queen Victoria loved it. So this helped. Because we could do that. Do you want to sleep through this? Queen Victoria loved it. So this helped hospitals got cleaner and they got better, but they also got more expensive and people were still a little hesitant, especially as they got more expensive. They really didn't want to go because it was super expensive and so unless they got really sick They were a lot of the beds in a hospital every night would remain empty.

And hospitals wanted to fix this. And they got an idea from cosmetics. Really? So at Baylor University Hospital in Dallas, so many noticed that people paid more for cosmetics each year than they did for medicine. And the reason that they figured is because it was piecemeal. You don't go to the store and buy all the lipstick you'll ever need in your entire life at once, you know, you buy a tube of lipstick and that's affordable. And then

you buy another one when you need another one. The idea was why don't we sell healthcare like that? Okay. People, instead of having to come when you're super sick and rack up this huge bill that it's going to take you years to pay off, why don't we offer that you can pay a small fee each year and then we'll provide you health care as long as you keep paying that fee each year. Maybe you'll need it, maybe you won't, but you've already paid your fee. So they offered a group of local school teachers a deal that you could pay 50 cents a month and in exchange, the hospital would take care of you.

If you came in, if you were sick, if you come in, you just get taken care of, and you've already paid your 50 cents, so you're good. The depression hits soon after this, and this idea really takes off because lots of hospitals are starting to have this same problem, they have even more empty beds after the depression, so more and more start offering this idea, hey, 50 cents a month, all the care you need, all the hospitals wanted in, and this initial idea they call blue cross.

Paul, don't do. That's just, that's like, uh, there's a cliffhanger. Wasn't? I don't know, it was a cliffhanger. It was more of a, it was more of a, and that's the rest of the story. Now, you know, yeah. Lower us, that was a story.

Uh, said, I wanna know more. You can't just like leave me hanging. There's more, Justin, but first we gotta go to the building department. Well, let's go. The medicines, the medicines, that ask you lift my car before the mouth. Hi, I'm Comedian Emily Heller, and I'm cartoonist Lisa Hannah Walt, and we're the host of Baby

Geniuses. Do you want to learn weird new facts? Do you like hearing successful creative women talk about their poop? Do you want the scoop on Martha Stewart's pony? If you answered yes to any of these questions, our show is for you. We interview people like Paul Lift-Homkins, Kristen Shaw, Michael Chase, and more. So check us out on Maximum Fun. And let us mess up your burn. Yes, please. So Sid, you were telling me you would just introduce the concept, the twist of Blue Cross.

Where are we going from there? That's right. So this Blue Cross concept, which was the beginning of, kind of, you can think about it as the beginning of like an employer-sponsored healthcare plan. But who was it real? I mean, like, who was organizing this initial? Was it the hospitals? It began to be organized by employer groups. So like, this was a specific school,

like this group of school teachers was with us, they would do it through one business at a time. Okay. So any idea you would make a deal with a hospital. So it was kind of a almost like an HMO to now as it spread throughout the country, it was done differently. It could just be your business, your factory, your whatever that made this deal. You pay us this much, you know, or they would pay on your behalf maybe. And as you begin to see this spread, it starts to mutate into kind of an employer-based healthcare system. Now, it's beginning to spread, but it's not everywhere.

What really helped it take off was World War Two. So with World War Two, we have this huge increase in production and stuff being made in the US. There are a lot more factories and we need a lot more workers. Now, at the time, factories, the initial impulse was, let's pay higher wages so we can attract the best workers to our factory, our business. Well, the federal government just anticipating that began to put wage controls on the different businesses. You can only pay this much so that that way they could spread the talent throughout all the different industries they needed and not focus just on who could pay the most money. That makes sense. In that light, employers needed other ways to attract

the best employees to their businesses and what's better than French benefits. So this is where we start to see the idea. So they get their own free Wi-Fi, their own computer, their own cell phone. Oh, I mean this is the 1940s, so no, they don't get that. So they don't like 10 cans in a string. No problem. You can stretch a 10-can string all the way back to your house for free. We'll do it. We'll have a guy who knows a guy. I think what you get is your kids get one of those hoops with a stick. You get to roll. You got you got kid at home, right? What do you think about this bad boy? Yeah, there's Flamety cows on it.

There's a hoop with Flamety cows on it. The stick got Flamety too, but the stick smells so you hit tells well. I feel like we're right. Like, I don't really know. I don't do toy history, but I feel like aren't we just on the verge of the slinky? Isn't this like coming up, you know? It feels like, well, yeah, the slinky was a military cast off, so. So I feel like this was the problem about slinky tongues.

Maybe give your kid a slinky. Yeah, slinky. Let me just Google that while you're getting pointy tongue out. I'll update you. I feel like it's slinky tongue. 18th century by chef to the Prince Bishop of Leish. The waffle. The waffle.

Okay, not Leslie Noop. So as they begin to come up with the idea of fringe benefits, other than slinkies, the real benefit was better health plans. So we will cover more. We will offer you more services because that was not included in a wage cap. So you couldn't pay him more than this, but you could offer them as much as you wanted in all of these other, you know, and not just healthcare, but retirement benefits and that kind of stuff. I guess this would have been the beginning of the idea of like 401Ks and stocks and whatnot.

of the idea of like 401Ks and stocks and whatnot. So with this, you see employer-based insurance really take root. This is the biggest boom of that. And what follows is in 43, you get tax-free if it's employer-based insurance, and you get another tax benefit in 1954, and this really spreads the idea. Now, as employer-based healthcare system is taking root in the US, there are people who have other ideas. Truman attempted to implement a single payer sort of healthcare system in the US.

How would that work? Basically, you opt in, because you're not forced to, you pay a regular fee and doctors who participate in this get paid by the government. There you go. Simple. Yeah, everybody liked it. No. That's why we have single-payer healthcare to this very day.

No, no. Thanks for listening to somebody, everybody. I've been... That's why we have single-payer healthcare to this very day. Nope, nope. Thanks for listening to some of these, everybody. I've been. That's an alternative fact. That's not true. No, what happened, and by the way, labor unions liked this a lot. But hospitals, the hospital association, the Chamber of Commerce, and I'm sorry to say the American Medical Association.

Don't be sorry. You're not a part of that. Well, I'm not a part of it, but I still feel responsible to the doctors. They hated it. So they branded it a socialism. Socialism was, as you can imagine, pretty scary to everybody. So it was completely shot down, and so the labor unions instead back to the employer-based system thinking that this would be something that they could actually make progress with. Like they can work with this and move this closer to what they wanted it to be, even though they would have preferred the single payer system that was originally proposed.

Now, the number... It is shocking to me that our inability to think big when it comes to healthcare or like really like have a vision for that is it like it extends back this far just like it's always patchwork it's always just like I don't know maybe the country's just so big that it's impossible like re it's like it's like a huge infrastructure project and I get that, but like, it's just our inability to like aim high for this, with this specific area is like baffling to me. Well, and I think what we're gonna see is I kinda walk us through what happens next,

is that this idea that just because we came up with the employer-based insurance system first, made it inherently better or right, or the best option. I mean, it just happened. And there were a lot of just things that, again, just kind of the depression, World War II, these, I don't want to say they're accidents,

but they were things that just happened at that moment in time that forced this forward. But, again, not necessarily because it was the best, just because it was what was. Well, I get also, I can see where you would be with something where it's like life and death like this. It's not like you get a trial run, right? Like you have to get it right.

Right. And the, once you start down a road, the idea of overhauling it becomes more and more difficult. We've said that with healthcare for a long time. Every day we don't fix it. It's going to be more expensive to fix it. Now you see the number of people with employer-based health insurance go from 9% in 1940 to 63% in 1953. Wow.

So obviously this idea caught on pretty fast. By the 60s, 70% of people have employer-based health insurance. S like you was 1943, by the way, so we're like right on your mind. Exactly. I figured it was slinky time. Yeah. Now, even though a lot of people have employer-based health insurance,

you still have a lot of senior citizens and people who are living in poverty that have no access to care, because if you didn't have a job that provided insurance, you didn't have insurance. that provided insurance, you didn't have insurance. Right. So in 1965, we see, and this was a series, but in general, in 1965, we see Medicare and Medicaid signed into law.

And so then you get like a publicly run option for either older Americans. So Medicare is for senior citizens. Now people over 65, and Medicaid for people who are living in poverty. I wish I could find the person that name those two things in bunch of them in the throat, why honor? There's the same thing. It's just the same words.

You've sinning them. I know. It's infuriating, old aid, senior aid, something, come on. I know. I used to get them confused. I don't know, but it's also... Well, that sounds good to hear. I used to get them confused. I don't know, but it's also. That sounds good to hear. I'm not sure my relief.

That's good to hear. I'm gonna take back in med school. Now, again, in the 70s, we see Ted Kennedy proposing a single payer system. Again, so we're still pushing back against this idea of employer-based health insurance as necessarily the status quo. Nixon actually countered with something that looked fairly not completely but similar to

the Affordable Care Act. If you want to be honest, there were a lot of things in it that look kind of like the system that's in place, well, as of the recording of this podcast. Now, as everything kind of fell apart with Nixon's presidency, so did all of these plans for healthcare. The next big push was with Bill Clinton in the 90s and Hillary Clinton, frankly. They tried again that the proposed system by the Clinton's was again sort of similar to the Affordable Care Act.

But insurance companies hated it, and all of the employer-based insurance companies programs fought it very hard, and liberals felt like it still isn't quite the single-payer system that we want, so nobody got on board with it, and it fell apart again. Finally, in 2010, under President Obama, we see the passage of the Affordable Care Act. So this is really a bill, this concept has been floated since Nixon. We find, and now obviously it's different, but same kind of idea. And it provided expanded Medicaid, expanded Medicare. There were these, when you talk about the healthcare exchange, kind of these pulled risk groups that you could buy into. So other insurance policies that might be more affordable for you.

It expanded employer-based coverage, and it created the mandate, the ever debatable mandate, which forced you to get health insurance. Basically, you can't just not have insurance, and then when you get sick, go to the hospital and rack up huge bills. You gotta get insurance. Because as you've said to me many times before this will pass, we already have guaranteed healthcare

for everybody, it's the most expensive system in the world. Yes, it's the most inefficient, expensive way to do it, which is when you get sick, just go to the ER, as opposed to having access to affordable care. There was a public option which would have been the beginnings of a single-payer health care system in the original of Orbal Care Act, but that got cut out with all of the arguing over it as it passed through Congress. So we've kind of decided in this country that health insurance is something that if you have a good job that provides it, you get, and if you don't have a good job that provides

it, the government will come in and offer you some sort of option. Right. And this is where we've landed. Okay. So where are we right now? Through the various changes that were made by the Affordable Care Act, between 20 and 30 million more Americans got coverage. Some of that was through the expanded Medicaid program.

Some of that was through the healthcare exchanges. Some of that was related to letting kids stay on their parents' insurance up to the age of 26. Some of that was through not allowing insurance companies to refuse coverage to people with preexisting conditions. A lot more people got coverage. The number of uninsured Americans dropped from over 40 million to less than 28 million or to around 28 million, sorry, by 2015. The percentage of Americans without insurance is less than 10%. It's like 9.1 or something

percent for the first time period, for the first time ever period at the end of that sentence. So we are the most covered we've been at this moment in history as a country. As of January 27th. At whatever time. 11.46 am. Now there are some challenges, of course. Cost is still an issue for people who are trying to buy private insurance. I know plenty of people personally who were really worried about the mandate because they still can't afford any of the covered options that are out there. They're working.

They just and they so they don't qualify necessarily for Medicaid, they're not old enough for Medicare, but they still can't afford some of the options of healthcare. So that is still an issue that we have to figure out. We've got to get young healthy people to buy in. A lot of people who kind of have that like, I'm young, I'm going to live forever. Who cares about health insurance? Attitude, it hurts the whole system. Because we need those young healthy people who are going to... And you can't get them with taxes, because like, they don't care. No.

Taxes are April's problem. It's like February. Woohoo! We've got to get those people into the system, because yes, you're gonna pay in, and you're not gonna use as much when you're younger, hopefully. Hopefully. But as you get older, you're gonna pay in and you're not gonna use as much when you're younger, hopefully, hopefully. But as you get older, you're probably gonna need it. We all are, and we all need preventive healthcare.

So, you know, go get your vaccines and your cancer screening. The cost of healthcare is crazy. That's a big problem. And it necessitates that we get results and that everybody get on board, because it's so expensive. And that obviously is one of the big challenges is reducing the cost of health care as well. Now if the ACA, the Affordable Care Act, if it goes away, which I'm afraid is inevitable,

I feel, I feel is an inevitable, hopefully I'm wrong. The Medicaid expansion that happened in 2010 is gone. So everybody who got Medicaid after the expansion will lose it. Therefore be uninsured. If you have Medicare, you're probably going to see higher premiums. You're going to see higher deductibles. Your drugs are going to cost more.

And we're going to reopen something called the donut hole. Now, this is a crazy thing that, again, took me quite a while to understand in my medical education. In Medicare, there's always existed this donut hole in your drug coverage. So once you spend up to, I think currently it's around $3,000 on medicines that's covered by Medicare, they make you start paying for it until you get to $4,000 in something dollars and then they'll start paying for it again. That's definitely...

It's crazy. That donut hole used to be a lot bigger. I cope with it because periodically as my patients who are on Medicare get to the donut hole, I got to switch all their meds to something way cheaper. All of their medical problems are not as well-controlled as we're trying to switch around meds and figure out what'll work and I'm trying to find patient assistance programs. then eventually we rack up enough debt that we get back on Medicare and then I can actually take care of them again. We're going to see that donut hole open back up again. The other thing about Medicare to know and this is going to affect all of us over the next 10 years spending is going to be up to 802 billion if the affordable

care goes away. So that's gonna affect everybody, not just people on Medicare. Spending by who? On Medicare, by the government on Medicare. Okay. Which means our taxes that we go to Medicare. Why are we gonna spend more on it if it's getting worse?

Because of, it was a more inefficient system before. Okay, good, good. So we're going to the inefficient one. Yeah, we're gonna go the inefficient way. Perfect. Okay, good. So we're going to the inefficient one. Yeah, we're going to go the inefficient way. Perfect. Okay, small businesses premiums are going to go up. You no longer probably will have to offer coverage, which was part of the Affordable Care Act.

So I guess if you want to stop offering coverage, I don't know if that's an advantage or disadvantage. I'd say the employees would say it's an disadvantage. So that's how, but premiums are going to go up. And for everybody, here's how it's going to affect you. If you have a preexisting condition, an insurance company can once again deny you coverage. If you are under 26, if you're between the age of 1926, you can no longer be on your parents insurance. There will be no enforced preventive care services. So once again, your

insurance company can deny to cover vaccines, pap smears, mammograms, colonoscopies, whatever you need, they can deny it. Anyone lifetime limits are back, meaning that if you are unlucky enough to have necessitated like a nick you stay when you were little, you may hit your lifetime cap before you even leave the hospital. Good luck with that. You can also charge more based on age. We used to charge seniors three times more for insurance. So you can do that again, engender, women consistently get charged more or used to get charged more for health insurance before the Affordable Care Act. So that's coming back.

You also don't have to cover maternity care. You don't have to cover mental health services and you don't have to cover black lung. So all the black lung benefits are going away too. So these are all the changes that are going to happen when the Affordable Care Act, I assume, is about to be rolled back. What is going to replace it? I don't know.

I have no idea. Yeah, I don't think anybody knows for sure. There apparently are a lot of secret plans that are very great that no one knows about. I've heard things about privatizing Medicare, leaving Medicare up to the free market. All of these things that I just mentioned about lifetime limits and charging seniors more and women more and kids and all this stuff, if you leave it up to private insurance companies, they can do that. I mean, you lose all that regulation. They don't have to cover anything they don't want to.

So if you privatize Medicare, I mean, if I were a senior citizen, I would be firmly against that. And they're talking about Medicaid block grants. And what that means is that right now Medicaid is an open-ended benefit, meaning that the federal government will give money to each state based on need. So as more people have Medicaid, more money flows into the system in your state, or as new treatments, novel treatments are developed that might cost more money or new things that Medicaid is going to cover, there's more money allowed to cover that.

If you give each state a block grant, they choose how to divvy up that money and it won't change. So even if you add more people to Medicaid or new treatments become available or you want to cover more, there's no more money. So what's going to happen is essential services are going to have to be cut and Medicaid is going to have to be more and more sparse to cover the people in the state for the period of time that you got the grant. Who?

Okay. for the period of time that you got the grant. Who, okay. If you're an outside observer, the, the seems like, well, wait a minute, people are gonna get sicker, and overall, it's, people are gonna have to spend more money on it. So it's less efficient, and also makes people sicker.

So where is the pressure to make this go way coming from? So one thing that the Affordable Care Act did was if you are on the higher end of the earning spectrum, you probably paid higher taxes, thank well, I mean, you certainly paid higher taxes because of the Affordable Care Act. I guess if you pay your taxes, you paid higher taxes. If you don't, you know, you probably didn't care. Those people will benefit, I guess, you could say from the repeal of the Affordable Care Act because those taxes also go away. So if you are a, if you are on the high end of the income spectrum, this would benefit you. If you are on the high end of the income spectrum, this would benefit you.

If you are on the high end of the income spectrum and you have lobbying power, I can see that you would use that lobbying power to try to repeal this. The other pressures would be the insurance companies themselves. It'd be interesting to know where the hospitals would come down on this, because I know our hospital has seen an improvement because more and more of the patients they take care of are covered.

If you don't have health insurance and you have a hospital stay, there's no way you're going to be able to pay for that. And the hospital knows that. We're still going to take care of you. The hospital knows that they're never going to get paid. So they'd rather insured patients come in. But a lot more regulation came with the Affordable Care Act and depending on your opinion on how involved the government should be in health care, you might not appreciate all that regulation and oversight.

Certainly there are some doctors who are opposed to it who feel that medicine should be more of a you pay for what you can get and you can get like catastrophic coverage for horrible accidents, but otherwise you should just pay out a pocket for things. I would not be one of those doctors. So there are segments of the physician population that were against the ACA, but I'd say the insurance lobby is the biggest thing. That would be my guess. For me, I just want to take care of people and I think a lot of physicians feel the way I do.

I just want to be able to take care of people. And my personal view is that a single payer healthcare system makes the most sense. I think the Affordable Care Act moved us closer to a system that would allow us to take care of everybody. I mean, that's all we need, right? We need everybody to have access to affordable healthcare, preventive health services, and medications that they can pay for. And to see your doctor when you're sick, so that you don't end up in the hospital because you've been so sick and you couldn't

you couldn't afford to get to the doctor because that doesn't make sense for anybody. So this is where we are. I don't know what's coming next, but I will tell you this. Before the Affordable Care Act, we figured out ways to take care of people, even people without insurance, and we will figure out ways to take care of people no matter what the current administration throws at us. We've been doing that all along. We will figure it out. We'll get through this. So, you know, I don't want to scare people. If you're about to lose coverage, don't worry. Your doctors are thinking about it too, and we'll find ways to take care of you.

The rich should pay the physician more than enough, because he cannot charge the poor towards whom he must extend his charity. That's going to do it for us this week on solbona's. I won't say I hope you've had it fun, but thanks for sticking around, I guess. If you care about these issues, wherever you come down on the political spectrum, I would really urge you to call your representative in the House for the Senate.

There are a lot of changes being made right now, and your voice should be heard. So it doesn't hurt to call your local representative. It's really easy to find out. If you Google, who is my representative, you can find out instantly, you just put in your zip code and they'll tell you, and tell them how you feel about healthcare and what you think should happen next.

And thank you to all our sponsors. Thanks to Maxime Fund Network for letting us be a part of it. And thanks to you for listening. We've run long, so I'll cut it there, except to say thanks to TaxPater for letting us use their song Medicines as the Intro and Natural Bar Program. And thank you to you, Sydney, for doing such a great show. Thank you, Dad.

Again, we can week out. I mean, never let me down. Do my best. Until next week, my name is Justin just Mac Roy. I'm Sydney Macros Always don't drill a hole in your head Alright! Maximumfund.org Comedy and culture, artist owned Listener supported