(Sorry this machine translation sucks, we'll fix it as soon as we can)
I'm David Torcivia.
I'm Daniel Forkner.
[0:04] And this is Ashes Ashes, a show about systemic issues, cracks in civilization, collapse of the environment, and if we're unlucky - the end of the world.
[0:12] But if we learn from all of this, maybe we can stop that. The world might be broken, but it doesn't have.
[0:19] Daniel we got a very spooky show this week for October, the spookiest month of the year, and in fact it's part of a whole spooky series that we're covering throughout this month for the next 3 episodes, and in fact this is the most terrifying topic I can think of.
[0:35] What is it David is it.
[0:38] Spooky scary.
[0:40] I'm guessing it has to do with the bills that we're going to be receiving in the mail pretty soon related to our intellectual property show.
[0:47] Oh yeah I sort of push that into the back of my mind and.
[0:51] Well I spoke to you.
[0:53] I'm trying not to think about it but you're right it is Bill related it's just not exactly those bills that you think I'm talking about health care baby.
[1:03] That is boot.
[1:05] We all have this huge fear of the doctor it's something that a lot of us grew up with one more little you go to the doctor you can shot it's no fun like I don't like this place, environment there is sterile it smells weird there's a bunch of sick people that's chairs in the waiting or uncomfortable the magazines they're all wrinkled and gross and old the fun place but as we grow up and get older and experienced the doctor firsthand as the person that brings ourselves to it as much scarier for Los Angeles. And I know I and many other people are terrified of being sick. Because being sick is not just about own feeling bad I'm going to go get help they're going to make me feel better mentally and then I recover hopefully. What is also this extra step we're after this conversation of okay here's this thing to help you feel better comes the really spooky question now how are you going to pay for this. And it's really the center of the show end of the next couple shows how Healthcare has turned from about helping people. Too bad extracting as much money from each of us as possible.
[2:07] And Healthcare in America and that's what the show is Healthcare in America gets a lot of attention obviously there's a lot of controversy in Congress about how to pay for healthcare, and a lot of people understand that it's out of control at this point the spending the costs and many people relate David to exactly what you just said the fear of what's going to happen if I have to go into the hospital what's going to happen if I get sick. Will I be able to pay for it with my family suffer this is truly a nationwide problem. 20 to 25% of our gross domestic product goes to the Health Care spending which is two to three times that of other countries for no additional benefit. 20% of people under 65 that have insurance cannot pay their health bills easily and half of everyone that is uninsured are struggling with Health Care bills. In the past 10 years spending on health services for people with employer Insurance increased 44%. But at the same time the burden of paying for these cost have increasingly falling on individuals themselves in 2007 only 5% of these insurance plans have high deductibles by 2016 that number jumped to 29%.
[3:23] In fact Health Care spending demonically outpaces the growth of our economy, every your health care spending increases by almost double the rate that our GDP does meaning that what little growths that we see in our GDP annually well most of it is made up of the fact that many of us are paying far more than we can afford in order to protect our health.
[3:42] We live in a system David where patients have no idea what the cost of a particular visit or operation will be in part because cost vary wildly depending on the wear and The Who. Costs can literally vary by a factor of 10 for the exact same procedure, or medication in this really can't be exaggerated in Elizabeth rosenthal's book an American sickness, her first case studies a patient with psoriatic arthritis who gets billed well over $100,000 per visit every couple of weeks. For a 3-hour and fusion of a drug that cost just $1,200.
[4:21] We are collectively paying more for health care than any other place on the planet we're not really getting anything additional for our money. For example people diagnosed with cystic fibrosis in the United States live on medium 12 years less than people diagnosed with the same condition in Canada. In the past 20 years the price of insulin has gone up 1200 %, causing many people to ration their use or simply go without it I was supposed to case for Alec Rashawn Smith a 26 year old who died in May of this year because he's simply could not afford is insulin.
[4:57] David this is a personal topic. Health Care in America something that impact so many different people in so many ways so we thought it would be appropriate in this show to incorporate some personal stories. Here's a written comment that someone wrote To Us quote what really gets me is the fear of having to go to the doctor because of the cost. Certainly there are preventive measures one can take to keep from getting sick or injured but often times we end up feeling like the chances of us getting food poisoning or slipping on a patch of black eyes and injuring ourselves might as well have been dictated by a coin flip. People shouldn't be scared to go see a doctor they should feel welcome and in good hands and if a price tag is preventing that then we have to reconsider how we approach Health Care.
[5:44] We agree we ought to reconsider how we approach health care and so this is part one in a three-part series on Healthcare in America. In the first part we cannot go into every little detail of the system, Nord believe me would anyone want us to but we want to provide enough evidence that suggests the system of providing Healthcare in the United States has been derailed from the tracks of social good, the one that Wall Street is well acquainted with profit and return the bubble, and this is fundamentally a different narrative in the one that says high cost on what we pay to incentivize life-saving Innovations in quality Care no this is not a normal system this. Is it broken system.
[6:27] We said we would incorporate some personal stories let's start with j.
[6:31] My name is Jan and I currently live in Windsor Ontario Canada
Juanne From Ontario [6:36] and about 10-12 years ago I went to California I was going to a conference there screenwriters conference because I'm interested in script writing and I was staying with a friend in Ventura.
[6:51] And yeah we went to the first day of the conference and we had lunch in the hotels and then on our way home we stopped at a Burger King to get a couple of Diet Cokes and then we got home the next day we were both violently ill with food poisoning we were so sick we couldn't both go to the conference we were really out but I was really really ill for the next this was on a.
[7:18] Thursday to Saturday night my friend and I and another friend of mine they said we're really worried about you we think you should probably go see somebody and I was like yeah probably a good idea going to a hospital and there were two hospitals and I said well why don't you know Hospital a witch was right there I'm from Canada to me I I was like whoa public Hospital what's the difference they should know you don't want to go to a public Hospital trust that you don't want to go to a public or a private Hospital you know I figured that Stokes we went in there and it wasn't busy so I was seeing pretty quickly that it will what's your problem I describe you know and I'm throwing up I'm constantly nauseous I can't keep anything down and they said okay it looks like you have food poisoning so they gave me an IV for hydration because it was pretty hydrated and they gave me up and they did that by IV push and I lay there for about an hour and a half and get me on my way and I didn't think anything about it so I'm back home in Canada about a month later so then about 2 weeks later I get a letter.
[8:33] From my travel benefits Star Insurance and it says you know we received this from the hospital in California and we're just passing it on to you to let you know this is what the charges were and we've actually negotiated it down but we wanted you to have this for your records kind of thing and I opened up the enclosed and I just about had a stroke because it was, it was for something like $2,000 and they had negotiated it down to something like 1,200 and this is for 3 hours and the one thing I remember really really clearly which was $600 for the IV that's for a bag of saline water basically it was $600. And then for the consult with the doctor and the nurses time and all the rest and then probably the administration fees or probably a chunk of money to, for 3 hours. I know you do the math that's a lot of money for 3 hours, I feel very badly for anybody in the state doesn't have any kind of insurance who has to make that decision do I go to the ER I don't either because I don't have, $2,000 or whatever to pay for a a three-hour visit.
[9:49] Jen makes a good point and you know $2,000 is not that much compared to.
[9:55] I was going to say like we are so jaded at this point I was like $2,000. Terrible I mean I guess this was a decade or so ago but still like in my messed up and I'm like $2,000 after a visit to the doctor's that's not crazy even though it's like they literally just gave her like she mentioned but.
[10:14] Right because we've read stories about people that went to the doctor for various things and came home with a $600,000 bill so obviously things can get a lot more expensive but this is a great example of the uncertainty around going to, the hospital in America not knowing what you're going to get and it's easy to see you know we've talked about present in our episode the robot is in about Automation and the threat to workers worldwide who are facing falling wages and how little people have in savings $2,000 is a lot of money there's many Americans that don't even have that much in savings.
[10:49] I think over 40% of Americans.
[10:51] Right and so the idea that you could go to a restaurant have a little food poisoning and then your entire savings could be wiped out as a result it makes sense the people live under a healthcare system that makes him a break.
[11:04] Absolutely Daniel and I think especially noting that she has a Canadian just really isn't used to this and so what were barking at this $2,000 number saying it's not so bad it's so outside of her experience you can even be billed this much for a for almost nothing because there are alternatives that work which maybe we'll discuss at some point this is something that would have she would have had to pay more for parking in Canada then she would have for the actual treatment itself, but here we are treating somebody for just dehydration and it's enough to bankrupt a huge percentage of Americans and because of that reason medical debt is the leading cause of bankruptcy in the United States and it should come as no surprise to anybody already but after the end of this episode you will definitely understand why.
[11:45] Well to move on David luckily for Jan she had health insurance that took care of it and many Americans do have health insurance and likely wouldn't have.
Insurance And Surprise Charges [11:53] Space the bill that she received.
[11:55] At least on paper.
[11:57] Right so let's talk about insurance for a moment here David because even though on paper some of our bills may be paid the fact that costs are rising so dramatically in the American Healthcare System the fact that services. Pills medical devices ambulance rides because all these things are so expensive well it's bad for everybody because it drives up insurance cost. It dries up the premiums we have to pay it drives up the deductible limits that were on the hook for and it encourages these prices to keep climbing.
[12:29] And there's one word for health care insurance Daniel and it is complicated. It's difficult to understand all that is going on behind the scenes especially when you do everything you're supposed to do and still wind up with surprises here's a comment somebody wrote on a medical-related. I once had to go to the emergency room which is in network what are the doctors that came to me was out of network so is charge out-of-network charges even though the hospital was in that war. Fabulous Health Care System we have really did a swell job of putting our heads together on this one America. You laughing but this actually happens a lot know what happened was this individual was likely seen by an emergency room doctor it was acting as an independent contractor which the majority of ER doctors in this country now are.
[13:16] Yeah that's right David so let's break this down for a second. Most people with health insurance understand that there's a network of hospitals that will take their insurance in an order to receive covered care they need to go to one of these hospitals, but the surprise comes when the doctors within those hospitals are not covered within their insurance Network. So just to clarify the hospital you go to is covered by your insurance but one or more of the doctors within that hospital that actually cares for you. Their not so how is that even possible how is that legal David.
[13:49] You think about it this way if you got into a car accident and then you went to get your car repaired, your auto insurance company says yeah okay this mechanic shop it is covered until you go when you were paired but then you get this humongous bill because while the shop was covered decks on mechanic that worked on your car was an independent contractor they came in from somewhere else so you're on the hook for their work, even though the shop was just providing space and really honestly not much more than that it's crazy but it's something that is standard and expected in the medical system. How this is all legal and it's complicated and not ready to explain it to you but it's possibility will make more sense when we get to medical coding and strategic billing. But for now what's important to know is that fewer doctors than ever are actually employed by hospitals. Many are now independent contractors who sell their service on their own terms, mystery has been particularly pronounced among behind-the-scenes specialist at is pathologist anesthesiologist radiologist and er Physicians, many of these people create their own practice and then sell their service to hospitals refusing to do business with any insurance companies.
[14:57] Hospitals benefit because they are no longer liable for these practices but who loses out patients. When you go to the hospital to get surgery for example in your surgery in network and your hospitals in network you may think everything is covered until you receive that surprise Bill a few weeks later they indicate that the anesthesiologist, you never met was out of network is now demanding $10,000 or whatever figure they feel like charging.
[15:22] And so this Arrangement results in a lot of surprise bills for patients and very expensive bills as these doctors the whole reason they don't want a contract with insurance plan is because insurance companies don't want to pay the exorbitant fees they're charging so a lot of these surprise bills patients get.
[15:38] Are also extremely expensive but insurance is so complicated in so many ways we heard from Winston from the Northeast United States who used to work in a call center for a major insurance company that worked with mostly Medicare customers so people over the age of 65 and then he worked for a legal marketing firm working with Social Security cases and he told us a couple stories that we're really heartbreaking in one situation he remember speaking with a Medicaid patient who was trying to decide how to afford care for their children and they were asking him questions like will look if I get a divorce, will it make it more affordable for me to get my children covered because of the very complex ways that Medicaid restricts coverage based on how much money you make or how many assets you have if you're a low-income family and you own two cars that's actually going to negatively impact your ability to get coverage but if you get rid of one of your cars and get that full coverage now your income might suffer as only one parent can get to work, on the other side he tells stories about how many Medicare patients fall into what's known as the donut hole trap where Medicare agrees to pay for their medication after certain deductible but because of their multi-drug or generic drug combinations that they have to take that to ductable.
[16:59] Isn't reached within the year where the budget reset for their insurance plan is so they end up paying a very large share of their retirement benefits on medication that is supposed to be covered by their plan, but they never reach that deductible level.
[17:14] And that's even with good insurance with something like Medicare for many Americans who are forced to purchase health insurance because of the Affordable Care Act. Where you can only afford the lowest-level catastrophic insurance you might be paying thousands of dollars a year for this insurance and insurance may have to duck tables of five or $10,000 which is money you don't have in the first place so even if you do get sick you're still going to be bankrupt despite already setting aside thousands of dollars for this insurance in the first place, this is very clearly A system that is sick but understand how Insurance got this way and we need to look back at where insurance came from.
[17:51] That's right let's take a step back David cuz I feel like forgetting a little bit in the weeds here.
Insurance'S Humble Origins [17:56] Insurance was not always this complicated as a very simple origin story that eventually went down a much different direction in the United States compared to other countries, the first form of American Health Insurance really took shape in the 1920s at a Texas hospital to help cover cost the hospital offered the Texas teachers union a form of insurance. Teachers could pay $6 a year and if they were ever hospitalized their entire stay was free up to 21 days minus a copay of $5 a day for the first week, and this plan was so successful he was adopted all over the country and it was called Blue Cross.
[18:36] So this plan was an individual thing like you would come in and decide to contribute to it yourself any part of it and it quickly expanded beyond the teachers unions and people were signing up on it and then Blue Cross was devoted to being a non-profit system it was solely there to protect people and to make sure that hospitals could still stay open and people if they got sick when he bankrupted by the process it's all changed right after World War II. So the time the government had Frozen all forms of wages salaries and bonuses in order to Spur the wartime economy which made it hard for employers to attract workers, so many Employers in order to get around the freeze on wages offered to pay for employee health insurance as a way to attract labor as a result the range of health coverage, exploded Blue Cross by DeFranco Blue Shield and a majority of Americans signed up for this coverage. Insurance at this time was still non-profit all rates were the same and no one was denied coverage.
[19:33] But the large market for insurance incentivised the creation of new private for-profit companies to get into the insurance game. They could make money by marketing more tractor plans solely to fit and healthy segment of the population. And it's a bit she left a non-profit Blue Cross Blue Shield plans with the most risky and expensive clients of course this means that BlueCross BlueShield had no choice but to eventually go down the for-profit route. Raising rates and shedding its commitment to provide affordable healthcare for all in order to avoid bankruptcy.
[20:06] And this is really a story of how competition in the insurance Market drove up prices and locked segments of the population out of affordable care and just continues to go on to this day.
Insurance Competition Raises Costs [20:18] And there are at least two important ways that I think we should point out David how competition among private and Shores really harms everybody. The first you have regulation that requires insurance companies spend at least 80% of their money, I'm paying for actual patient medical bills.
[20:37] That sounds like an okay thing.
[20:39] You know it is and it was one of the things that the Affordable Care Act, fought hard to implement you know it means that because insurance companies are paying 80% on care they only have 20% left for marketing and other business activities nevermind you David that Medicare spends 98% of all their money on actually paying for people's care but let's stick to the private Market or just a second here to David picture this, you're a big bad insurance company all right.
[21:09] Awesome I'm rich.
[21:10] And you know that in order to maintain a profitable slice of market share in your little corner of New York. You've got to spend a million dollars a year on marketing that's just what you have to do to maintain market share. Any less than that and you lose customers your condom use of scale will break down and you're going to start losing money. Well here's the problem David your client only racked up four million dollars worth of claims last year. Which means you're spending 25% of your money on marketing and advertising which is over the legal limit but then I walk into a hospital David I'm on your plan. And I've got this rare infertility disease that not many people have. And the hospital that I go see because it is a rare disease what they decide to charge you a million dollars. I know it's a lot of money David you know it's ridiculous I know it's ridiculous but you sit down with your Countess and you realize you know what it actually makes sense to pay this because now that puts your marketing budget below that 20% threshold, making it legal and that's good for your bottom line because that's what you need to maintain your market share so you do it and that's the price of keeping you in business and profitable that's the price that we all pay, slightly higher premiums for everyone else so that you can maintain your business.
[22:32] So instead of just negotiating this figure down to something that I know is reasonable you know it's not a million-dollar treatment even of the hospitals trying to charge me that, I'd agree to accept this because it gives me that much more 20% for marketing or maybe I don't know my salary it's something that I want, 20% of a large number is 20% more for me to do whatever you need to. But of course I have to make up the difference with an extra million dollars because it's not in my budget and like you said how do I do that by raising all of my members premiums. Another way Insurance competition raises prices for everyone else depends on the bargaining advantage of providers over Ensure even if my budget was fine Daniel if I didn't need that extra 20% bump I still might decide to eat the high cost of your medical bill because if I try and fight it, I'm a small enough insurance company at the hospital might choose to just drop me as a partner and then I lose all my other clients to someone else because who's going to want to use me if no hospitals are covered by my insurance plan.
[23:33] And then because you accept that charge and the hospital gets away with charging a huge sum it becomes to standard. All insurers pay because now hospitals realize they can get away with it and insurance companies again will compensate for these increased prices, hi raising premiums or raising deductibles across-the-board so that's what contributes to situation where it cost several hundred dollars to visit a physical therapist who is going to show you how to strengthen your wrist by picking up Sam.
[24:03] This is one of these Vicious Cycles it continues to make things more and more expensive, so I the insurance company to agree to pay disfigure the hospitals like they paid that all increase it next time and see how much more wings out of it well I don't want to challenge this and in the bargaining or needed extra money for whatever budget I need so I could have paid again. On and on this vicious cycle climbs and climbs and it may be part of the reason why insurance premiums. Climbed so rapidly over the past few years with some states teen increases at 50% over just one calendar year. I was talking about the other side of this equation the hospice.
[24:40] Write in hospitals have a lot of power and they're gaining power.
Hospitals Flex Their Power [24:43] And not last example David where the insurer chooses to eat a higher cost because negotiating with a more powerful Hospital could lose out on business, this is something hospitals are trying to take advantage of there's consolidation going on in the country right now hospitals are getting larger in fact there's a proposed merger right now which will become the largest health system in Texas the Memorial Hermann provider plans to merge with Baylor Scott & White it will affect over 73,000 people who visit these hospitals, and one of the big Spears is that it's going to raise the cost of healthcare because this much larger provider will now have much greater leverage to negotiate higher prices with all the insurance providers in the area. But once again David hospitals have a much humbler beginning historically.
[25:31] For long-time hospitals and other medical providers were unconcerned with Prophet financial decisions Beyond those necessary to stay afloat just weren't considered, you're often born out of large donations charitable groups like religious organizations in the same way that the American College of Surgeons used to though he were there used to never charge patients beyond what they could pay hospitals saw themselves as a public service to the local community and part of their Duty was to provide care for the poor and the ill at no cost. But the idea the hospital should be run like a business change all that and really started taking off in the 1980s. Congress got rid of a law requiring hospitals to prove that there was a community need before investing in new facilities or machines. And Hospital started hiring NBA's other business-minded people Tampa size their desire to improve am I going to say help to improve patient Health Daniel.
[26:26] Maybe quality of care.
[26:27] Quality of care to success rate.
[26:29] Maybe lower it lower the times lower the amount of infection.
[26:36] It's the bottom line and at the same time Consulting companies started advising hospitals on something called strategic billing, and the final blow Wall Street stepped into Finance new Investments to pay for all this that could generate guaranteed returns for the financial investors.
[26:55] Among all this new interest in turning Healthcare into big business David hospitals begin stripping and Outsourcing all departments that were not generating enough profit, one of the most notable examples of this is dialysis you mentioned a few weeks ago on how so many of the topics we cover contribute to diabetes well as the number of people with diabetes has increased and the ability for hospitals to squeeze profit out of dialysis centers has plateaued and even declined in some cases, these hospitals responded by shedding the services and selling their patients to large for-profit companies like Fresenius and DaVita. Today more than 90% of dialysis patients are treated by these profit-making companies who have turned these enormous profits by cutting costs over billing government insurance in marketing dangerous products, both Fresenius and DaVita have paid hundreds of millions of dollars in settlements as a result.
[27:55] And as you would expect these Trends don't support patient help compared to nonprofit dialysis centers patient have between 19 and a 24% higher risk of death, at these large or profit centers than the nonprofit one. And in general people who undergo Dialysis in the United States have the highest mortality rates in the world and even so or perhaps because of this reality. DaVita and Fresenius Medical bind 1.8 billion dollars in profit in 2017 alone.
[28:27] No reading about the way that these patients are treated in dialysis centers but it's it's really honestly horrifying kaniel hospitals basically sale, Anna and Elsa were. I'm choosing to use they basically cell patients or like 70 to $80,000 to these dialysis centers revenue for the dialysis centers from the insurance is coming in and then they just like it's really treated bodies like not too different than a slave labor thing but instead of Labor that they're purchasing they're purchasing the fact that this person is sick, any treatment to survive and insurance is going to foot the bill, but it quite literally is a trade of bodies and there's a dollar sign apply to every individual body in that process.
[29:10] Do you know what I think is really interesting about the fact that hospitals in order to be more financially attractive to investment is they said these departments that aren't making money and maybe that makes sense to us now like we've become normalized to this I go it makes it makes perfect sense at the hospital, is it making money on something you shouldn't do it but. But think about what we're talking about here. We're talking about health care we're talking about providing someone care for a disease or an illness and traditionally this is what hospitals have been about helping people who can't afford care helping people receive care it's not something that was ever meant to be profitable because it what profit is there in disease David it's a negative thing is it cost to society no matter what there's no profit to be made from someone getting sick in our society.
[30:00] Where they shouldn't be.
[30:02] Well yeah I mean if someone is making money off of it means we're all losing out in some way because it's already lost and we should be and I guess the question is does it make sense to consider disease and illness as a business opportunity or should it simply be, a cost to society that we all pay for. Focus our attention on the quality of care in on prevention so that that cost can be as minimal as possible.
[30:29] I'll bring a preventive care I think is important here in this is one of the major departments that was slashed, by this process to try and strengthen the bottom line because preventative carries is hugely not profitable for these facilities, let me think about this way if you have somebody coming in and they need something stitched or if they need a medication or they need treatment or surgery or something the hospital can build a lot of money for that and we'll talk about coding and upcoding and stuff in the moment that's where the story sort of really gets dirty if it isn't already but. Preventive care is something that we should all be aspiring to like this is the most important part of the healthcare process because the better that we can keep people healthy and out of these hospitals the better-off society and all, we're huge Friday reason one just because quality of life in general is improved for both individual and for all the people around them.
[31:19] Burden by somebody sick you know them by their medical bills, in a burden by treating for them caring for them worrying about them of the loss of a loved one that's something that could be prevented by this preventive care all these things are important and hard to assign external cost to, but they're usually usually dyeable course those cost don't show up in the bottom line if you want to get that canonical with it you could have signed something with lost work productivity gains by keeping people healthy the cost of Medicare eventually when it does get to that societal cost if you can keep people healthier longer than you. Can be paying as much money for them when they do eventually get sick what are General preventive care things like exercise things like eating right basic check up some physical few things are discouraged, and we are encouraging people to get sick to live unhealthy lies ultimately that's more profitable for the Healthcare System itself.
[32:10] When we do get chronically sick David we become the ultimate consumer right I mean if the for-profit dialysis companies are making you know close to 2 billion dollars a year in profit that Surplus money, then they are directly benefiting from, what are the most deadly chronic diseases in the world right now diabetes and so does it make sense for these for-profit companies treating this disease to support anything that would actually prevent it. Maybe not but David enough from us let's hear from another personal story.
Joel From Dc
[32:45] Hi my name is Joe from Washington DC.
[32:48] And I got it started and robbed I need the number for 10 minutes later. Sorry I was going to be days after that AT&T, I go to the hospital and they checked me out and make it to the Contrast MRI and. And they said you don't need stitches some bandages and tell your hairdresser. And indicated they're like how are you.
[34:15] Where is this happening was my Works Chadwick General Insurance if there are injuries or the solid rock or something so I guess I fell under that, almost $10,000, I got one for the doctor one for the amount I work for the shot at once in the ambulance and there is another one that they had wear, $6,700 in dollars, working search for.
[35:12] Bill Pizza driving is like one of the most dangerous jobs actually they did they get robbed and attacked all the time like salute to Pizza drivers you all are I'm way more danger than cops so like hats off to you.
[35:24] David let's summarize the story really quick from Joel was on the job got attacked gets sent to the hospital he's there for what 3 4 hours they teach him how to dress as well.
[35:37] The whole time complaining that he can't pay for any of this.
[35:41] Right they don't give him stitches and then they sent him on his way and he gets a bill for $10,000, that's insane you know luckily his company paid for a majority of it I wonder how much he was he was on the hook for though in imagine if he hadn't been working for the pizza company and in this it happened she was just driving home from the movie, would he have been stuck with that $10,000 bill himself as an uninsured person and what might that have done for his future.
[36:09] Medical bankruptcy Daniel the answers medical bankruptcy I know a guy who was in a car accident and broke both his arms I think. Went to the hospital and they treated him and took care of him and then you have this at the end of it this medical bill that was reaching six figures and he just was like you know what screw this and he just dropped out of society and now he rides around the country as a whole Bowl itching on trains because he can't afford to do anything else you can eat for some reason he didn't declare medical bankruptcy probably because it's complicated and a lot of people don't realize that's an option in the first place and so he hasn't held a single job for years besides just like for cash migrant work where they can dock his wages or collections come and find them and he's literally living the life of a hobo because of his medical and back in if Joel hadn't have that workers insurance and he very likely might have ended up in a similar situation and maybe not traveling on trains but certainly with no. With what to do and how to pay for.
American Medical Coding Oddity
[37:11] Will all of these stories David that we've heard they involve confusion over the amount that is charged, Joel received five separate bills in the mail and this is common experience for millions of people in the United States, you go to the hospital thinking that you're going to receive a routine procedure next thing you know you get a 20-page bill in the mail with a list of expensive charges that you don't understand I'm part of the reason for this is the way the United States uses medical codes which is different from any other country its first let explain David what is a medical code.
[37:44] It's a great question then on the origins of modern medical coding the game way back in 1893 when Prince position Jacques put the old along with several others could of the classification of causes of death. This was commissioned by the international Statistical Institute to standardize All the known causes of death so that they could be identified in any country and track to cross borders World Health Organization took over the system in the 1940s alone even greater standardization around the world, it became known as the international statistical classification of diseases injuries and causes of death the mouse pull so let's simplify. The ICD wallpapers of his Global effort is to provide a public good for tracking and understanding Global Health patterns. United States increasingly use medical codes not just for announcing cause of death before financial reasons adopting more and more complex codes for insurance and business purposes. What that means is that codes are used to inform Financial value. The code for heart failure for example is 4 to 8 and the code for acute systolic heart failure for 28.2 one is a billing difference. Thousands and thousands of dollars.
[39:02] This has led to the emergence about three decades ago of an entirely new profession the medical coder. And huge Industries has sprung out to support these coders with opposing goals there are coders that work for hospitals and other providers that try to figure out how to build a patient from Maximum profit. While there are coders that work for insurance companies that then try hard to reject the codes hospitals charge and also you know they tried a Lobby Regulators for lower value code. And it's crazy how much this back-and-forth search for profit has ballooned out of proportion and how complex the practice of billing patient has become there's a big industry dedicated solely to educating Physicians Hospital staff and he's medical coders themselves on how to maximize their profits and avoid losing money it's part of something called revenue cycle management. Here's some copy David from one of these companies called billing Paradise.
[40:00] Meditate this topic name.
[40:03] Club as a physician you need reliable and efficient business intelligence systems which provide automated revenue reports of your practice, unless of position is ready to lose large sums of money understanding medical billing reports and using the right software to provide automated revenue reports, is a must in quote it's a what their software does in part is it tracks every single medical code a provider uses. It tracks the revenue they make from these codes and how long it takes patience to pay the provider back it didn't makes recommendations on how the provider can describe different codes to make more money or change the way at bills also that the doctor or Hospital can maximize the amount of money they make from patient.
[40:50] Hold up stop right there record scratch so this software is literally designed, not in order to help the health care of the patient or to maximize their quality of care or anything else it's solely exist, to maximize how much they can charge that patient, that is the entire purpose of this software is it okay we could have a four to eight point whatever but it will increase it to this 4 to 8.21 will it more profit for the hospital and ultimately for the doctor we will talk about anymore.
[41:22] When a lot of these medical coders David they don't work alongside the doctor they don't follow you around when you go to the hospital out of them work from home you know they're mobile they get paid hourly, it so it can create some interesting situations where patients are billed for things that never happened to their examples of patients that, that give birth and then they receive a bill for you know something like circumcision which they never had the doctors perform but these medical coders they look at the situation they say okay this is what the patient went through these are likely all the procedures that happen, we can make more money if we bill for this versus that the insurance company likely can't refute that because I don't know exactly what happened to me to get the complex and to be fair David it's not like the business is selling these services are inherently malicious.
[42:07] Yeah right.
[42:08] Their trying to help hospitals and doctors dreamline their administrative tasks avoid errors while the same time increasing Revenue. But the fact that his industry is necessary in the first place is a symptom of an overly complex system it definitely driven system in the money these companies make is coming straight out of the pockets of the American people we are the ones paying for them.
[42:32] But hold up your thinking why would my doctor someone who's taking the Hippocratic oath to do no harm allow the hospital to alter the codes at patient is billed for. You might be wondering why does the doctor not simply write down exactly what they needed to do to provide you the right care and then have the hospital their staff or whoever just bill you exactly for that. Well I mean Number One Mini doctors never see the bills, they have no idea exactly what you're being charged for but beyond that and here's where it gets really dirty there are additional perverse incentives going along with these medical codes that incentivize the doctors themselves. To engage in a process called upcoding hospitals have a long history of demanding Physicians to bring in more revenue from converting them into those independent contractors.
[43:21] Paying them based on the amount of Revenue they bring in that's why you probably didn't know this but your Healthcare is commission-based just like when you buy a used car at that shady car lot, in fact today over 70% of all physician practices are paid in some way based on their quote productivity what that means is that when a patient comes in and describe the symptoms the doctor has a choice, we can perform a basic service like a steroid injection which is just a quick shot, or use an unnecessary ultrasound machine to assist the injection which of course will add a few hundred dollars to the service is the position chooses not up code their colleagues do they'll be punished with the lower income.
[44:02] When that's from the hospital perspective David that you mentioned earlier in this episode about those out-of-network doctors the anesthesiologist the pathologist the ER doctors, that are Contracting with hospitals and then billing patients who have insurance and then refusing to contract with the insurance the patients have resulting in higher charges will the explosion of these types of physician own specialists, and the centers that they open this has been driven in part by the profitability of these codes.
[44:34] When Medicare created a system that's used for determining how much it would pay for these medical codes it turns the management of that system over to the American Medical Association which is made up of Physicians themselves, and these positions then Lobby the association to improve the value of codes specific to their practice so imagine there's one pie of money David at medicare's willing to pay each year. Two Physicians as a whole and then how that pie get split up is determined by the American Medical Association, you know if it raises the value of one coat has to lower the value of another one, but because of the way that this process is structured specialist get a lot more power and leverage to negotiate and Lobby for their codes then the generalist which has led to extremely profitable specialist practice is like Radiology, and like physical therapy at the relative expense of other physicians in so they're really two brought forces going on here that are driving the bills up related to these codes.
[45:39] On the one hand medical coders are looking for ways to apply as many codes. And what the highest value as possible to your particular visit and then the positions themselves are incentivized to perform as many steps as possible to add as many ancillary services, to their process to qualify your visit for those higher charges.
[46:01] This process is so slimy, an ethical Duty as in disgusting and then we'll deal with people that think so in fact the American College of Surgeons as we mentioned change their ethics code to get rid of the part that said I will never charge patients beyond their ability to pay from their pledge American Medical association's code of ethics used to say that their Physicians fees quote should be commensurate with the services rendered and the patient's ability to pay, it sounds nice but that latter bit the one about the patient's ability to pay will that was later removed in the 1980s these groups and realized. A change their own ethical standards. To include the ability to exploit us for the care that we have provided the charges as much money as they possibly can in order to profit off our disease or sickness. A lack of help. When do we turn our hospitals into used car lots where doctors are working on commissions depending on how much they can charge us how many tests they can run what expensive drugs with we'll talk about in the next episode when expensive treatments care, anything that can possibly imagine. Click on in order to make more profit like this is so gross how do we get so far from the idea that health care itself should be non profit should be provided for as little as possible even free those who cannot pay.
[47:22] I need the north was so far gone at this point. There is no saving the system and the Affordable Care Act attempted to do that but in many ways made things worse as we talked about with a catastrophic insurance people being forced to pay for insurance that still will bankrupt them when the bills come due, the entire system is sick it cannot be cured and we need to put it down and start with something else but who is really to blame for this process, we all know it was at the people who are paying the closest attention to the bottom line.
[47:51] Will David someone might criticize us as being a little bit too idealistic here I mean we're saying how the profit incentive that has infected this system of healthcare is wrong, and maybe someone will see that as looked it's just not realistic we live in a world where things have gotten more complex disease has gotten a little bit more complex and we need to spend more to treat it and we need to incentivize all these doctors and these providers to innovate a solution and if that means they get paid and that's just the cost, that it that it takes but let's examine real quick another startling Trend that might suggest something else,
Emergency Service Private Equity [48:30] and that's the increasing role that Wall Street private Equity is playing in this giant equation is he in the wake of the financial crisis, private Equity firms sweat into many sectors of the economy to purchase distressed assets and Investments for pennies on the dollar and then used techniques for cutting cost filing suits, increasing prices and lobbying for regulation in order to make money. That's the goal of a private Equity Firm what does they're using the money from pensions Banks or investor cash the goal is to purchase an asset at a discount, squeeze the asset for more money and then dump it or sell it, or enjoy The Returned after stripping it of pesky things like employee benefits or employees themselves.
[49:16] And although wall Street's most infamous roll after 2008 involved the housing market, Burns also approached cash-strapped municipalities and bought up things like fire departments, where they made money by introducing really clever Innovations like billing people for showing up to their burning homes the New York Times reported in 2016 how one of these private fire departments, sued a man for $15,000 after showing up to his house once it had already burned to the ground, but the same article also reveals how firms bet on Emergency Services as a good investment and bought a number of services like ambulances. When the money they thought they make didn't pan out these firms either file bankruptcy which disrupted ambulance response time or slash costs by laying off EMTs, or in one case even encouraging paramedics to steal medical equipment to keep their ambulances stocked the private Equity or not, just about every Ambulance Company now charges a fee to deliver people to the hospital. And in the same way the hospitals used to teach a billing to maximize the amount they can get from patients ambulance companies do the same thing.
[50:28] Rosenthal's book an American sickness she writes as in all the other sectors of medicine ambulance companies progressively, unbundled their bills. A Los Angeles with sets charges for all ambulance providers the base rate for an ambulance ride in 2014 was $1,033.50 or $1,445 in advanced life support team is on board plus $90 per mile, $51 for every 15 minutes of waiting and that didn't include extras such as to 8475 if it's after 7 p.m. 265 75 for the use of an oxygen tank 2725 Reed ice pack band need your oxygen mask, and because insurance companies often refuse to pay for these specific types of charges most people are stuck with the bills out of pocket.
[51:17] Once again here's Joel on his experience.
[51:20] Because the ambulance took me to a different hospital than the one that is called and I don't know why I don't know. That was, sure is that condition you can't bring yourself in the hospital it's just saying that your life.
[51:45] Note especially crazy about these ambulance charges Daniel.
[51:48] What's that David.
[51:50] Is that the EMTs themselves or writing in these ambulances were driving them almost nothing, so I mean we can understand maybe the extremely high amounts of money that we pay for HealthCare coverage within a hospital where the doctors are making six figures or quarter million dollars whatever it is Comfortably it's expensive it's expensive to have a lot of doctors like that and it will get the residency labor in a moment it's easy to think about this nurses doctors it's expensive, EMTs make on average maxing out about $40,000 annually and it's after years of doing this, but a single ambulance ride come back up bills for thousands of dollars who's profiting off this is not the people actually doing the work it's a company that owned these ambulance systems and then dusters behind those.
[52:34] And hospitals take advantage of the low pay that these EMTs make the so Joel mentioned in his story how the ambulance didn't take him to the closest hospital but took him somewhere else and it's likely because he was uninsured these Angeles teams they often have the freedom to take patients to any provider, and hospitals find ways to incentivize them to bring in the insured patients which they can make more money off of and keep the uninsured somewhere else. But as you alluded to David there's also other ways hospitals are taking advantage of low-wage Labor.
Residency And Training, Or Free Labor?
[53:08] I tried I know it's not just ambulance companies taking advantage of the low wages that they can pay the employees doing much of the work but hospitals themselves are more than happy to exploit the labor. Doctors to be in the form of their residency programs at least residency programs are an important part of the American Medical system it's where dr. to be trained. In actual practice to become a doctor. We can hands-on experience actually working with patients doing different treatments learning from people who been there for years become familiar with the practice at those soon be joining. It's a long arduous process it's three years usually but they work very very very long hours typically 36-hour shift and it's grueling. Make sure they have no social life and devote their entire life for years to this process with the hope that eventually will become a full doctor and be able to pay off their quickly growing medical school loans.
[54:00] Now they are compensated for this practice most salaries for residents range from about 50 to $80,000 a year with additional health care benefits employee benefits things like that the actual average compensation is about $130,000 annually hospitals make somebody calculated this about a quarter million dollars from every resident. And that's before Federal subsidies for each of these residency positions of amounts over $100,000 meaning that for every resident at hospital brings on, are making on average Coastal quarter million dollars in pure profit. How to no wonder that hospitals are scrambling to get as many residents as possible on to their staff and because of this the federal government has set limits on how many residencies can be at each system and increasingly they also set limits on how much these residents can actually be worth. Cutting down on some of the dirty dangerous hours that they were working for years which is something we talked about in our sleep episode where you know staying up for 36 hours is going to lead at long-term health effects but also, problems in the way to your Ashley performing your duties during your ship this has caused hospitals to panic.
[55:05] And so to compensate for the reduced working hours that they can get out of these residencies they've cut down on the actual educational portion of the Residency program meaningless times watching procedures less times attending lectures and it said more time doing routine medical procedures like blood draws we're looking at charts things that make the hospital money we are sacrificing the education of our future medical professionals. In order to increase the bottom line right now. And it has a fax on the patient help at the moment and it will have a drastic effect on patient Health going forward in the coming decades as these residents become full-fledged doctors but with much less education in those from the years.
[55:45] Referred a couple stories David about how this broken system affects people personally, I'll navigating it can be like navigating a bureaucracy Nightmare and in a Costco novel and the high charges that people received and so he was a final story for us that kind of highlights the absurdity of a number of intersecting, parts of the system from the ambulance to the charges to the lack of choice. And for those of you who may be disturbed by stories of depression Suicidal Thoughts. This particular story has those themes in it if you would like to skip ahead about two and a half minutes to avoid that we would encourage you to do that, now.
Matt From Nashville
[56:30] My name is Matt I am from Nashville Tennessee now this happened actually in Boulder Colorado and I lived over there, but it was a very low point in my life I move to Boulder Colorado to live with this girl terrible I T I know but, after 2 years, everything just fell apart I mean I was like fuck it I am just going to kill myself so I attempted to hang myself and soon as everything kind of start blacking out. I was like I can't do this so I immediately.
[57:02] You know I'm crying all of this shit and I call the suicide hotline cuz I see it all the time online like oh if you're going through trouble call The Suicide Hotline and the person on the other line really did help. But about 15 minutes in they asked me you mind if we send someone to go check on you, I of course was like please I need some kind of compassionate human interaction at this point so 30 minutes into the call I get a knock on the door I go over there and it's two police officers they want to check my neck then they take me outside I put your shoes on we're going to take you to the hospital I tried to talk my way out of it and I know you're going no matter what. And a couple paramedics came over and they saw it and I like all right you're either going to go in the ambulance or they're going to take you in the cop car ambulance are going to have to pay for, and I was like alright I am not doing that y'all go on the top or another we don't trust you necessarily in the cop car so we're going to put handcuffs on you they took me down to the hospital kept me there for about 4 hours they brought a counselor in from 1B local detox centers and he talked to me and I helped you there for about 45 minutes and then while he was there he's like this entire consultation or whatever it is is for but I jump to the conclusion that the entire visit would be free.
[58:26] 4 hours then they asked me if I was going to go home or if I want to stay the whole night I was like I'm going to go back so I had a friend come pick me up the next day they called me. And asked me to come in again so I did and they gave me a bill for $3,600 for the visit. Yeah and I was like well shit I'm already paying bills out the ass I'm depressed as fuck, and now I have is so I had no idea what to do like I haven't paid it off I was definitely way more depressed afterwards and I told a lot of people about it of course like the suicide hotline is great and like no it is not in here's why, they will arrest you because you're a danger to yourself and then charge you for that.
[59:13] What a traumatic experience that is Daniel I mean somebody who's in that situation where they're forced to make that kind of call. And when you find yourself next thing you know in the back of a police vehicle make it to the hospital finally and then get basically no help and be billed for that whole experience.
[59:31] Right and I know this is this topic David's about health care but to me the stories just such a great example of how we as a society. Feel that it's so important to Outsource everything that makes us some comfortable everything that we should be handling ourselves and instead handing that off to professional. We have a society now where people among us are depressed, are unhappy Unilock connections with other human beings we tell these people look just call this professional hotline they'll handle you because we don't want to, this is the type of thing that can result is a very impersonal cold calculating system that looks at someone who's vulnerable and says what. You know fine will take care of you but here's your bill would you like to set up a payment plan is that really the best system for people who are in this kind of vulnerable state.
[1:00:26] I mean the obvious answer of course is no that is only a crazy sick society that can look at something like this and say well yeah of course we're going to Billy's thousands of dollars for the traumatic incident, but getting that situation in the first place like you mention our pathological nature to try and pass off everything to a professional is definitely exacerbating this problem.
[1:00:46] Suicide Hotline I did staffed primarily by volunteers they're not paid for this so they're doing a good job but it is something that is Holy impersonal. Training to know how to deal with people who might be suicidal who might be feeling this way but that's really the limit of their ability they don't know this person they can't reach out in the personal way. We have these these lines you see them all the time people are sharing know if you feeling bad here Suicide Hotline please call these things I used to people online constantly posting huge huge Links of suicide hotlines and every country like oh if you're feeling upset about this thing please call please call, but how impersonal hasn't decided God more this is what we have to do and the suicide hotline absolutely does provide a purpose you're the person who will always pick up and it's important, we should be able to call those around us as well now I've been on the receiving end of these types of calls before of people that I know friends. And I fortunately had had a little bit of training and I knew what to do when somebody's calling you talking to you suicidal how to talk to them what to say, what things you need to do in the real world outside of this phone call at the same time and because of this because of people like Daniel were able to help people who needed that we're asking crying out for help at the moment.
[1:01:58] How many people have that training is something that doesn't take that long it's an hour or two really and it should be something that we have in every single School. It should be part of our standard Healthcare System that extends not just to the for-profit hospitals and emergency rooms that we have right now. Put into the very nature of how we teach Health two children and two each of us in our communities and in our schools if we were better prepared to help each other, in the situation if we know, what to say when somebody calls us asking for help he's types of tragedies and fortunately this didn't end in tragedy but it very well could have could be avoided or helped or made less terrible and the financial burden that have balls from it, can be completely avoided. When we all know how to answer this phone call what to say how to help people that much more likely to get that call in the first place and this is important because things like suicide depression they are climbing they are exploding a trait that we've never seen before especially. Unfortunately I'm one of the very young middle schoolers high schoolers, and it's important now that we start teaching people how to handle these situations how to respond to these calls and the fact that it's okay to make the call in the first place and this is what we on the topic of this episode but it's something that I feel is important to get across here.
[1:03:13] The professionalization and the financial ization of our Healthcare Systems has moved away this care from individuals helping each other out, from communities providing things collectively to these cold and personal situations that invariably end up. Enormous bills at themselves destroyed people's lives just as much as a disease or health issues that cause them that go and ask for help in the first place.
[1:03:40] Like we said we barely scratched the surface of the problem here we have more episodes coming up on this for the following 2 weeks but even then there's only so much you can say about the. Deeply rooted systemic issues that are torturing all of us in this financial eyes. Healthcare System, but even then there are some things that we think we can do.
What Can We Do?
[1:04:02] First in terms of practicality I would encourage anybody who is dealing with medical related issues and feels confused feels out of. Pick up Elizabeth rosenthal's book an American sickness, it'll go a long way in helping you to understand some of the things going on behind the scene but in addition she offers some chapters in the later half of the book on actual practical things you can do as you talk to your doctor, as you receive bills ways to spot instances where hospitals are overcharging you how to dispute those how to negotiate for better concerts I mean it's unfortunate that we live in a system where in our most vulnerable moment.
[1:04:43] The moments where we are sick the moment where we are facing death potentially. We're making decisions about the future of Our Lives dealing with chronic illnesses those are the moments when we have to. Navigate a complex bureaucracy looking at every turn to confuse us to take our money but it is the reality at the moment in the more we can understand the more power we have to navigate that in to avoid being taken advantage of.
[1:05:09] And for all of us we should be looking and supporting and educating ourselves on a better system. As healthcare insurance is framed to us in America as a Marketplace were told that having all these choices is good for. It's good that we have so many different insurance companies competing for our business but as we've seen. That competition can actually raise prices and harm all of us at the end of the day what people want. When it comes to their health is not a choice not a Marketplace of insurance programs that they can choose from not an endless roster of, deductible plans and benefit plans and payment options what we want is the choice, of our doctor we want the choice of our hospital we want the freedom to choose the type of care we receive. We don't want the endless choices about money and business decisions and treating our life as if it's a trade-off between health, and financial disaster and so looking at some kind of single-payer system where we can cut out so much of these middle man simply taking advantage of, openings in market and ways to make profit could go a long way in helping to alleviate some of this wasted time and heartache that so many people in America have to go through.
[1:06:32] This is not a political issue despite what you've been tricked into thinking by the media and the Democrats and the Republicans. Single Payer Health Care or Medicare for all or whatever term you want to call it at this moment is a bipartisan issue. People across the aisle on the far right on the far left and everyone in the middle want this a huge majority of Americans want this. There is no lack of support for these ideas. People are fed up with the healthcare system rightly so and we want something that's different we want to change of this and it changes they're ready for us.
[1:07:14] Our politicians are not interested in this system and realize that they can come around to this because this is, something with so much support from both sides of the aisle it is something that we are having to drag them Kicking and Screaming across because they are at financially invested in the continuation of the financialization of our Healthcare Systems they profit off of this and the people who Lobby them profit off of this as well Beltre Industries approaching 20% of our GDP that's money we're spending to try and stay healthy. What are the ones who end up with that money those are going into a concentrated small amount of insurance companies of hospitals and Wall Street investors. I know some of us get the end results by our stocks that we might hold along the way that is not where we should be profiting we should not be profiting off this sickness of others, and the people who are most impacted by this of course are the poor are the minorities who are far more likely to not be able to afford this care, or more likely to not have insurance or four more likely to get sick in the first place because of the way our systems come down on them that much harder than those who have the means to avoid these problems in the first place. United States has amazing of medical care we have some of the best technology some of the best doctors some of the best training in the entire world. But it's only available for a very small amount of people.
[1:08:37] The rest of us live outside this can only look inside and say I could be healed right now I can be cured by this but it will ruin me I will be bankrupt my savings will be gone.
[1:08:50] It was a Nobel Prize winner who just died who had to sell off his Nobel Prize. Three-quarters of a million dollars in order to pay for his health care expenses as a. That is the nation that we're living in right now for even the most wealthy of us that price comes with a million-dollar Prize or forced to pay everything. And still not find a house that they're looking for this is a system that sick and cannot be cured we are not customers we are patients. And driving home the distinction is so important. I'm not usually one to advocate for legislative change but we have no choice here we have to step in and say medicare-for-all single-payer whatever you want to call it is not an option. Any politician who does not support these plans who doesn't actually War towards neighboring them and making them a reality is not our Ally, they are there to profit off of our suffering our pain in our misery and they do not deserve our support no matter what other policies they have. There is no option going forward this is a matter of life and death for a huge amount of Americans and anybody who does not support this is willing to profit off the death and pain of others and that is totally unacceptable. And I will not stand for it and I encourage you to do the same.
[1:10:14] Beyond that you can actually shop around for your health treatments you can call up hospitals ask him how much something's going to cost. And I'll give you a price list you'll spend a long time on the phone you'll have to talk to a lot of people but you can get these cost. So when your doctor prescribe something or said you should get some tests ask around and you can end up saving tens of thousands of dollars because you took the few hours it takes to make these calls. Of course the king at the luxury that only those of us with enough time in order to spend hours on the phone calling around shopping around for medical care can do but that is the reality of our situation at the moment.
[1:10:51] I hope for a day if the healthcare system can return to its not for prom and truly not for profit system there are plenty of not-for-profit hospitals that exist right now but they are profiting just as much as the private ones today by the pudding packages buy clever Financial Accounting they are there just as much to suck the money out of us has any other. But it truly not-for-profit healthcare system or profit doesn't even into the conversation or equation where were solely concerned with patient Health welfare and a healthier society and culture at all. We need globally States but here more than anywhere we can really feel the pain of when we are not given this. What you going to take anymore at this point. This is not an option we need something better we're not going to fix this broken system so it's time to ask for to beg for the world to me lead to take and create something new something better.
[1:11:47] That's really want to get involved in like the drive for universal healthcare when I get back.
[1:12:08] I thought it was all going to be free I didn't have health insurance I haven't had health insurance since I was in the military so. My dad there's no way of hanging off its just to this day I still don't have like TennCare Medicaid whatever you want to call it health insurance there's no way I'm able to afford that and I have medical problems to this day. And I know it sucks but whatever.
[1:12:35] And I will mention as well that because. Single tear here in Canada in the administration costs are much lower because you're dealing with one insurer which is the government and V because it is a single parent because it is a single negotiator the government. Negotiate with all the providers. Try to try these providers for jobs all the rest of it and still discuss our lower we do have a problem in terms of doctor-to-patient ratio but for things like if you have cancer you go to the front of the line if you presented the ER with a heart attack you're in surgery I guess the question is do you want to have to wait. To get your knee operated on or do you want to never get your knee operated on cuz you can't afford it.
[1:13:25] As always that's a lot to think about.
[1:13:28] You can read so much more on all of this and we really could you check out that book an American sickness by Elisabeth Rosenthal it goes into so much detail and really very clearly explains all the tissues but in the meantime you can read much more on our website as well as a full transcript of this episode. Ashes ashes. Org.
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[1:14:12] You can also find it on your favorite social media Network at ashes ashes cast next week we continue our health care coverage but turned towards the world Pharmaceuticals we hope you'll turn in until then this is ashes ashes.