How to Make Health Care Better and More Affordable

One Simple Solution for US Health Care
On this episode of Common Sense Soapbox, Seamus explains to Sarah, Ron, and Bob one thing that could vastly improve the US health care system and make it more affordable.
Is it more spending? Is it more insurance? No.
It’s something that would let the market drive down costs the same way it does in other well-functioning sectors: A functioning price system.
'What's that,' you say? Stay tuned and find out!
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CREDITS:
Written by Seamus Coughlin and Sean W. Malone
Research by Tyler Brandt & Matt Hampton
Reviewed by Michael D. Tanner
Storyboards by Mila Brosam
Animation by Seamus Coughlin, Natasha Borrero, Caleb Black, Jaime Velasquez, Amazil
Produced & Edited by Sean W. Malone
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LINKS:
-- Understanding Price Signals --
fee.org/articl...
fee.org/articl...
-- Health Care --
reason.com/201...
www.ada.org/~/m...
www.aei.org/ca...
fee.org/articl...
www.cato.org/c...
www.cato.org/c...
www.cato-unbou...
www.realclearm...
www.jstor.org/...

[@sircoloniser5454]

the US healthcare system combining the worst parts of public and private healthcare

[@MrCrashDavi]

+

[@clydewill2340]

pretty much, and the fact that the people have yet to dump this system is beyond me

[@MikeOck88]

@@clydewill2340 how is this the people's fault? what the fvck do you expect us to do? its much easier said than done

[@brackcarmony6385]

@@clydewill2340 Not too surprising. It's a really beneficial system to those already in power. And it becomes super easy to deflect any criticism with claims of 'People will DIE'

[@15743_Hertz]

Brought to you by politicos that don't want to fix the system, but rather use it as a platform to get elected and introduce more complexity into it.

[@IchNachtLiebe]

My girlfriend once was in urgent need of surgery. We went into one hospital and the doctor said they wanted to keep her overnight and see if the issue passed. I asked them, "So, you're basically going to do nothing and send me a giant bill?" The doctor literally replied , "Yes". So I walked out with my girlfriend in arm and went to a different hospital 100 miles away. The first hospital still tried to send me a bill. I fought the bill and didn't end up having to pay. My girlfriend got the surgery she needed at the other hospital. If more people were stubborn and didn't fall for the, "we're doing everything we can by doing nothing but charging you" sales point we could push some of the scam artists off the map.

[@MrCrashDavi]

+

[@IchNachtLiebe]

@@ashleypenn7845 It's crazy how our medical system works. I tend to be over-trusting and am highly agreeable. After years of doctors who don't seem to care or don't know what they're doing charging insane amounts but not creating any solution (often I later find out that there are simpler and cheaper solutions that have better long term effects) I've lost my trust in many professionals. I now question them directly and don't take their word on anything. It has worked out much better for my health so far. I have only a small circle of professionals that I'd take the word of.

[@ashleypenn7845]

@@IchNachtLiebe Nothing fueled my distrust in the medical system more than working in it for 5 years. It was so corrupt, I couldn't wait to get out.

[@shorewall]

Whenever I go to the doctor, I am reaffirmed that they know nothing. Care is fine. But diagnosis and treatment, it's like as if I was wearing a lab coat and talking to people. "Here's a prescription based on what I think it is. Take that and if the problem persists, come back in."

[@TheGuyWhoIsSitting]

I was in a hospital in Japan and I was like “are you guys going to let me leave? I have school to attend and they don’t give sick days…”

[@OntheOtherHandVideos]

I so appreciate that the way to make health care better isn't presented as a miracle fix - Seamus does a great job of not over-promising.

[@ActuatedGear]

Healthcare be hard, yo.

[@CyrusStratton]

@@ActuatedGear Social Contractor, is that you?

[@dustyh5599]

not everything is correct. "Prices are often mandated or heavily influenced by the government" 0:58 The government was prohibited from negotiating prices in the 'health care modernization act' of 2003, which was pushed by pharmaceutical companies. tarbell.org/2017/11/no-uncle-sam-cant-negotiate-lower-drug-prices/ It wasn't until recently bills were passed to let government negotiate again, but I think it's pretty clear all this healthcare cost inflation happened before that. But w/e, funny cartoon

[@thewiirocks]

@@dustyh5599 Just because the government isn’t officially allowed to negotiate doesn’t mean that it isn’t happening. The back and forth on DRG payments *was* the negotiation for over 2 decades. Hell, the MS-DRG system was literally a concession on the governments part to pay more for some services based on medical severity. (Though MS weirdly stands for *Medicare* Severity. But whatever.) That law was about as effective as the law “preventing” SSNs from being used as identifying information.

[@williamweigt7632]

@@dustyh5599 also: this refers to drug prices. Also important, but not the subject of the cartoon, today.

[@grahamturner2640]

The funniest part was that the person having the issue was made out of paper.

[@MyEpicbeardman]

Wouldn’t that be more severe though? It would be like if part of your finger or arm was severed.

[@abduljabars]

Aren't they all paper?

[@nwblader6231]

@@MyEpicbeardman he got a paper cut though, so it would be like if you were cut with a piece of human flesh

[@existinginaspace8347]

Some people are that physical fragile. I've met a few. Why some people bruise easy and seem to have pixi sticks for bones. Idk. Probably genetics.

[@squattingheads]

So a paper cut is like a flesh wound

[@Rickety3263]

Patients should approve the cost before services delivered. Just like EVERY OTHER COST IN THE WORLD

[@St33lStrife]

As an EMT. I agree and disagree. I agree because people should know what they're paying for. I disagree because I'm not withholding life saving treatment so I can get approval from next of kin, if they even have one.

[@SonofTiamat]

It costs people less to take their pets to the emergency room than it does for themselves. I know this from personal experience

[@BeckettOC]

But it isn't like every other service in the world, and comparable services are nationalised (speaking from the UK here). But there are historic examples of why this changed, fire services being one. If you didn't have insurance they let your house burn down. And even if you did, if you couldnt prove it when the fire service arrived they let your house burn down. So these things were nationalised which is sensible, unless you think that the fire service should come to your burning house, assess the level of fire at the time and give you a cost estimate of saving your home. Yeah routine stuff sure, but if youre in a coma they can't write a bill and then let you die before doing anything. (Not to mention costs from unforseen complications, which increase bills in the private sector all the time)

[@MrCrashDavi]

@@St33lStrife If you want to give people life saving treatment regardless of the cost, start a charity, don't have bystanders foot the bill for your altruism.

[@MrCrashDavi]

@@SonofTiamat In Brazil it's the opposite, vet's really expensive, but Government healthcare is totally free. Dentists are expensive too.

[@Saint_Wolf_]

Bob's character arc is better than the entirety of Cal arts animation arcs on TV.

[@GusOfTheDorks]

I miss the penguin.

[@makaramuss]

I love how he was a hard core leftist became moderate that just wants best for everyone

[@MalekitGJ]

@@makaramuss Bob: _Socialism is the answer!_ Government: Bob, you have to pay taxes. Also Bob: _Taxes are theft!_

[@doom5895]

Entertainment sucks now

[@Saint_Wolf_]

@@MalekitGJ so basically every socialist after they put in one hour of manual labor in a non-ac cooled environment.

[@mlevin7]

When people say that our system of private healthcare is broken they’re forgetting that we don’t actually rly have a private system. What we have is a horrendous amalgamation of both private and public elements which causes runaway increases in price. It’s actually pretty similar to what is happening to college tuition. As far as affordability goes, a fully public system may be better than what we have right now (although quality may go down), but going back in the other direction toward a private system will have even larger positive effects on affordability and on quality.

[@tugalord]

And a fully public would be pretty much unaffordable, even here in Europe we have a mixed system of public and private.

[@yulfine1688]

@@tugalord in canada the private systems that you can pay into while still having the public system what you pay goes into the public system anyways...because it's extremely expensive for the country...not including many other issues that do arise

[@dominicj7977]

Fully private systems will ultimately be owned by some private equity firm. that's when the costs increase.

[@firelordeliteast6750]

@@tugalord In europe, the public and private parts work in harmony. In the US, they fight each other and the working class gets punished for it.

[@Mintstar_Oceanpop]

And then Bob discovered how hard it is to open his own clinic.

[@baltoflyer7503]

A couple of weeks ago I went to urgentcare (a chain clinic). I had just went off my parent's insurance and was paying myself. I asked how much it would be and was told $100 which I paid upfront. A few days later I get a bill in the mail saying I owe them another $330. That's not how that works. You can't charge someone more than you told them for a service, except if it's medical, then they can charge you what they want, when they want, and make your life hell if you don't pay.

[@SupersuMC]

Funny thing about the papercut is that, with our excessive use of antibiotics, we're approaching an age where papercuts can kill. ._.

[@matthewpinner9419]

Are we actually?

[@mcarrowtime7095]

@@matthewpinner9419 not really, but infections will become more deadly due to the fact that evolution is starting to make some Bacteria immune to antibiotics

[@kevincockerham3806]

Phages are being looked at as an alternative to antibiotics.

[@HornadyMatt]

@@kevincockerham3806 came here to say that. When they become more resistant to antibiotics, they become weaker to phages and vise versa

[@kevincockerham3806]

@@HornadyMatt oddly enough they do have to be careful with it though, since phages can enter a stage where instead of killing it merges with the bacteria making a prophage were they then are reproduced like regular bacteria while making the most toxic chemicals known. Botulinum is made by prophage of the Clostridium botulinum. Then when conditions are not good for the bacteria boom, like a xenomorph pops out and becomes a phage again.

[@Ethan-zt7ky]

A few clinics already do this, they charge 80 bucks a month for any injection, any minor injury, any counseling, at ANY time with unlimited visits. Not to mention doctors can make even more money this way. All the while preserving the finest health care for those who can afford it.

[@watchdealer11]

Doctors are also overpaid with their supply artificially kept low by the AMA. We need to increase the number of med school seats and allow top international doctors to practice here.

[@Jerbt]

@Conservitarian 17 I mean some states are uhhhhhhh different from others, especially I believe in higher stare rights.

[@HarveyDangerLurker]

@@Jerbt hello while true, what will happen is medical professionals that are underperforming will be removed from the system as no one will want to use their services.

[@ootmaster1]

"We need to increase the number of med school seats" Yeah that will be great "and allow top international doctors to practice here." Nope Fck outta here

[@jackalenterprisesofohio]

@@Jerbt well how about we do the same thing we do witj driver's licenses Its okay to vacation or drive througj a state with a different state driver's license But if you moved there you have to change the driver's license to the same state....so How about this licenses have three classes class 1, class 2, and class 3 Class 1 this is alot like the driver's license, it allows you to practice occasionally(like a person has a stroke during your vaction and you are the only available doctor to do doctor and prescription stuff) and it can also cover non-profit organizations or programs (like how missionary sites in Africa sometimes has a doctor sort of way) that are based in other states...like say for example The Hawaii Food Pantry Organization sets up an emergency food donation center in say Iowa cause of drought or something the doctor liscene allows the doctor to work at the site. Class 2 This license is for regular businesses it can still function as a class 1 but this is mainly for tax purposes and so the government knows which state the doctor is doctoring. Class 3 this license is for specialties like optician and Neurosurgeon it still functions as a class 1 license but they are only allowed to donate their doctoring as what their license says like the eye doctor can't be the pediatrician for example at the Hawaii Food Pantry Organization. And I separated it into these three parts because we can add more different types of licenses without overhauling the system so to add a new type of liscene we just find out what part is generally falls under and add a undergrade for example say for class 3 since it doesn't work as a class 2 we add to class 3 class 3.1 this license works as class 1 but is limited to regular business so basicly the class 2 of class 3.

[@1krani]

Or we could just dismantle the AMA along with their de facto monopoly on doctors. For what is a monopoly if not an entity which controls the entirety of a certain market? Big companies control a whole market, we break them up, yet when a glorifies union like the AMA does it, we shrug and go, "That's how it is"?

[@SC-mf1gc]

Canada here: went in for an eye exam years ago and asked beforehand how much it would cost, so I could know if I could afford it, or whether it was worth it. They said they didnt know. How could you not know? It's like not knowing a price until after you buy something. Anyway, I went ahead with it. Simple eye exam. Loe and behold it was several hundred bucks. I a poor student. So I just said...well I didnt bring THAT much. Not much they could do since they did the exam first. So I just paid what I could and paid the rest later. Same thing happens at the doctor. They have no idea what anything costs. They just write a prescription for the name brand stuff, unless you request otherwise. In either case you never know what it will be until you go to the pharmacy and even then the pharmacist doesnt know until they fill the damn order and it's time to pay. You cant just be like, how much will this cost? It's insane

[@robrazzano2905]

I've always found it interesting that Healthcare is the only service you purchase and no one tells you how much it cost

[@hisgreasiness]

It WAS affordable when EVERYONE paid for their OWN insurance. The start of the downfall was in the late 90s when the insurance companies and hospitals started working together against the consumer, rather than against each other.

[@markdorn8873]

I suspect that was a reaction to the threat of government "help" and the relentless demonizing by the media. Circle the wagons, boys, we've got trouble!

[@hisgreasiness]

@@markdorn8873 well, the media and government definitely aren't advocating for us.

[@davegreenlaw5654]

@@markdorn8873 Look into the history of most industries and you will see that can be the case. The Hayes Commission in the 20's and the MPAA ratings system later on were in reaction to a threat of the government imposing their own restrictions. Same with the Comic Code in the 50's in response to government intervention in the comic book industry. (For the latter, look up a documentary called Comic Book Confidential.)

[@233kosta]

Isn't that what we call a cartel?

[@enskje]

@@233kosta Nah. Capitalism represents a free marked without government intervention. This does in theory include the possibility of the market cooperating and colluding. One really good example of this are Light bulbs. They used to improve every generation, some lasting for decades before dying. But lightbulbs lasting for decades is bad for sales, so the companies worked together to reduce the duration and thus improve sales. Any one not complying got forced out of the marked.

[@mackinbox]

I always smile when I see that there’s another common sense soapbox out

[@nathan1sixteen]

I always love the "that just means that rich people will be treated first" comment... Yes, because we all know that in countries with universal, taxpayer funded healthcare, rich people never get to jump the line... 🙄🙄🙄 If you believe that, I have some beach front property in Kansas to sell you

[@RicardoLuna]

Honestly don't udnerstand what's the problem with this. Is really a problem that rich people can afford the best smartphone first? or the best car? or the best house? The magic of the market is that there is an offer for everyone.

[@JayVal90]

The rich privileged people ALWAYS go first. The only ways to prevent this are isolating them from the rest of us, and/or having so much excess supply that “first” and “400th” have no real effective difference.

[@Walter732NJ]

Does that beach front property in Kansas have an open floor plan and an in ground pool? Also, it needs to have at least 3 bedrooms (preferably 4), 2 bathrooms, an attached garage, and a detached second garage/workshop. Bonus if it has a fence too. If I can get all that for the right price and we can somehow convince my wife by replacing the windows with ultra HD monitors showing live feeds from some oceanfront resort so she'll finally agree to move out of Jersey, I'll force myself to believe rich people don't jump to the front of lines, taxation isn't theft and common sense gun control works. If I can just get out of here...

[@surprisedchar2458]

@@RicardoLuna healthcare is a special case, as doctors aren’t supposed to discriminate and help everyone no matter what. So ideally it should be those in the most need first. If a rich person is in the most need, by all means they should go first. But if someone else is worse off, their health is supposed to be the priority.

[@dustyh5599]

As a Canadian it seems you're talking out your ass. As a non-rich person, my family has received life saving treatments without any excess wait time, and some rich people often complain and yearn for a capitalistic healthcare system so they could jump the line as is the inherent nature of those system.

[@St33lStrife]

All of the hospitals I've been lucky enough to do my clinicals in have had Charities for this exact situation. Now if only all of them did instead of relying on the government...

[@Chualland]

They used to before the great depression. During the great depression the US shoved its way into many things and making costs go up.

[@St33lStrife]

@@Chualland agreed. But it didn't really start until medicare and medicaid where hospitals and providers adjusted their pricing to acclimate to the spending power of a government. I despise government health insurance mainly because it incentives people to live unhealthily.

[@Chualland]

@@St33lStrife most providers couldn't tell you how much they charge. Which is stupid. They adjust to each hmo/ppo.

[@St33lStrife]

@@Chualland I agree, it's idiotic. I should be able to tell people the cost of some things and I should be able to be told the costs of some things. But the health care system is whack to the point you can't even compare like you could with a car or even regular insurance.

[@cr3070]

It’s so weird how if you mess up pricing transparency things get expensive real fast. It’s almost as if there’s no incentive from anybody to keep costs down.

[@ThinWhiteAxe]

"That's ketchup, sir" Me every time I watch a movie with fake blood

[@rys.1092]

My mom is a doctor, and I grew up with all that. Also worked for her for 10 years, and I can confirm that the system is broken. Can't list prices to be competitive, have to charge certain prices as part of the agreement with insurance companies. Beyond that, the disaster of medicare is not sustainable for any private clinic. Some real reforms are needed.

[@stevendoyel]

You don't understand how much Physicians HATE insurance! They dictate what procedures they will pay for even if it is not the best next step.

[@ramgladore]

Dr. Ron Paul made a great point about lasik eye surgery and how the cost became super affordable, even without the need for insurance. I may be paraphrasing him but how I understood it , its considered a non-essential medical procedure and because of that, government programs like medicare and medicade don't cover it. The prices came down because the factors that cause pharmaceutical companies to raise prices don't do the same with Lasik, especially if they know government will not front the bill. You can even shop around for the cheapest providers of Lasik surgery.

[@afrikasmith1049]

Common Sense Soapbox: (Talks about the best solution for healthcare.) White House: (Probably won't listen because they are too busy dealing with an old man that claims to be over 180 years old and can't think straight.)

[@TheAwesomeCouch]

Why would they? People with power aren't normally willing to give it up

[@pingo6able]

He laughed when he said 180? How do people not get it was a joke :I

[@db9944]

@@pingo6able Sure, it's a joke, but if the basic orange man said it, the "fact-checkers" would be all over it

[@mmacd316]

@@pingo6able The orange man made jokes (that people actually laughed at) and the media reported as if he was serious. Did you have a problem then? If yes, carry on in your confusion. Great work being fair. If no, then you now know how many people felt when the orange man told a joke and people lost their minds. On a side note, based on facial expressions I don't think Biden was joking, I think he was befuddled. That's my opinion though and I'm keeping an open mind. Neither of us can say with certainty what another person's intent was. The best we can do is guess.

[@pingo6able]

@@mmacd316 which jokes? I've seen him say some wack things with a straight face

[@thesong7877]

If anyone wants to know what universal healthcare would be like in America, just look at the VA healtchare. That's basically what it is.

[@davegreenlaw5654]

Another big problem I see is that many hospitals are now part of these big HMOs, that seem to be more concerned with profits and shareholder dividends then about healthcare itself. That's why I have a problem with many medical companies listed on the stock market and held in mutual fund portfolios. But then, I continue to say my rant about how all that mess is due to the modern-day shareholder who treats the stock market like it's a casino.

[@ACollectionOfBookmarks]

Please search "Preferred Countries Act" it's a bipartisan bill Crenshaw was talking about. Basically if the USA is the biggest consumer of medical products (drugs, equipment, etc) in the world we should be given the lowest price that is given to other countries. We should not be paying the world's subsidies. We should be given preferential treatment since we give pharmaceutical and medical supply companies the most business. It would force these companies to be reasonable with a base rate and other countries would have to pay a few dollars of their own money so we don't have to go broke over a $30 bandaid and a $2k ride in an ambulance where we were given hundreds of dollars worth of a packet of saline solution.

[@ootmaster1]

fck crenshaw

[@drawapretzel6003]

even better, price control like the UK does, where we audit the hospital and drug system, and actually make things cost the amount they take to make, plus a little extra to cover making more. If a company can profit more than 1.6x off of medical supplies then they dont deserve to exist. 2.6x cost is good enough for every industry, why not healthcare?

[@maciampi]

More doctors like myself every day are doing Direct Primary Care (DPC) in which they contract with patients directly rather than insurance companies. The cost is $50-100/mo for all the services a family doc provides, including office visits, email and texts. We also get great cash prices on labs and meds for patients. The subscription doesn’t cover things like surgery or chemo, but that is what insurance should be used for.

[@ohsweetmystery]

I love the idea of an actual doctor/patient relationship and it seems like a no-brainer for us patients, but how difficult is it for a doctor to survive and pay for equipment, office costs, etc on that much?

[@abigailstone823]

It has always been ridiculous to me that I can’t get a freaking price list at the doctor. Honestly, what other good or service is bought without knowing the price??

[@matthewevans5486]

It's always ridiculous to me that you Americans even need a price list for medical care

[@abigailstone823]

@@matthewevans5486 why?

[@matthewevans5486]

@@abigailstone823 because people shouldn't have to pay for the ability to not die

[@abigailstone823]

@@matthewevans5486 people should pay other people for services rendered. not dying is entirely up to you and is not someone else’s responsibility. certainly nice for people to help other people not die, but a doctor is not a slave bound to free service. they shouldn’t be money grubbing pharmaceutical reps either, but there’s a middle ground here.

[@matthewevans5486]

@@abigailstone823 health care is as much a service as the fire department, police force or running water and I doubt you'd be happy to pay at the point of use for any of those

[@akidmyself4053]

1039$ for a lab fee. And I have insurance. We could also cut costs if we took better care of ourselves as a nation. It's estimated 2/3rds of all medical costs would be cut if all Americans were at a healthy weight.

[@PAcifisti]

Your issue is not the actual price but the jacked up price. You've gone to the profit bingo-limbo where "everyone" has insurance so the hospitals can demand whatever crazy number for the services as the bigger entities can afford it (which does raise the average insurance price AND governmental subsidies). Similar services in Europe even on private clinics cost a fraction of what US pricing does. Your state uses more money per citizen on health care than most European nations do WITH public healthcare for everyone at free / reasonable prices.

[@person3070]

Where did you get that figure for the 2/3?

[@MorganJ]

Also right to try is super, super important. We shouldn't have situations where people with chronic health conditions are forced to travel to other countries to get certain tests, procedures, or treatments done.

[@mcarrowtime7095]

Why are you talking about the British health care system?

[@trparnell87]

@@mcarrowtime7095 and Canada. Lots of cancer patients rather fork over the money than race a clock.

[@yulfine1688]

a lot of countries even in america theres regulations of certain medications that other countries ban including different treatments some are indeed good bans however theres plenty of them where its nothing more than to allow pharmacies to continue selling a more expensive version as for treatments Im not fully sure on that one. America has more MRIS CT PET scans than any other country some hosptials have more than entire provinces in canada. Some hosptials systems yearly operating costs hit over a trillion dollars most are billions to hundred of billions which is pretty insane. Theres also when it comes to cancer treatment not a single country that can compare@@mcarrowtime7095

[@2vnews902]

New constitutional amendment needed: Make government run entitlements illegal at all levels of government. Only direct financial assistance (cash/voucher) at the state and local levels for those who qualify should be allowed.

[@sid2112]

On relief, like the old days. It worked and people did get help. They also got off of it as quick as possible because of the shame associated with it.

[@iandick1364]

@@sid2112 Unfortunately, it has become shameful to shame people. Other people will get mad at you for judging someone who needs some outside perspective. Then people fail because everyone is effectively lying to be nice to them.

[@sid2112]

@@iandick1364 Fortunately I have no shame, so it all washes out :)

[@nemonada1323]

Don't forget to specify that only individuals, not their businesses or companies, are eligible.

[@rinrinsparkles1986]

Like a negative income tax.

[@scruffythejanitor1969]

Things works best when those receiving the service are also PAYING the cost and are able to provide direct feedback (either verbally or by taking business elsewhere) to those providing the service. Also: more doctors. LOTS more doctors.

[@keithricker504]

A coworker and I were just talking about something similar two days ago. It was one of the best conversations I've had for a long time. I am definitely going to tell him to check this out. Thanks for the work and effort you put into all of the videos you do.

[@evilblackcat6357]

Step 1: Remove government influence and control. There is no step 2.

[@EmperorTyrael]

Step 2: Profit.

[@evilblackcat6357]

@@EmperorTyrael It's an inevitable consequence of removing the puppet hand of government from the collective arse of the economy and not so much a step. I getcha though.

[@markcrawford5810]

@@EmperorTyrael For all.

[@MakerBees333]

@@EmperorTyrael the reference goes step 1: w/e step 2:(none). Step 3: profit! South Park underpants gnomes.

[@Mintstar_Oceanpop]

Profit is step 4. Don't know what step 3 is beyond the question mark forest.

[@ttthttpd]

Required to study recent approaches to reducing costs as part of job training (EHR software), and this entire video's thesis is like 1 slide out of 8 lessons. The things being pushed here are 3-fold: 1) improved communication to reduce redundant tests/procedures, coordinate better care (less readmissions), and reduce wasted time/effort on charting. 2) Value-Based Reimbursement, where the money recieved by the provider/hospital is not based on number/type of services (Fee For Service) but on quality measurements/outcomes. For example, shared savings takes FFS but averages out costs and those providers below the average and at or above quality measures get a proportion of the savings as a bonus. Another good one is bundled payments were a typical price for all services associated with a disease/issues is determined and is used for billing the entire package. For example a hip replacement would include the pain meds, surgery, hospital stay and rehab in the single bill. 3) Population Health, focusing on preventative medicine at a population level. This is a complex subject with a lot of programs by gov and businesses right now. A standard definition cant even be agreed to!

[@revolutionfrommahbed4246]

I have an amazing chiropractor who only takes cash - no insurance. Her fees are low, her treatments are awesome. Her practice is small (just her/one treatment room/two tables - not a lot of bells and whistles) but I can afford my care from her and she can afford to offer great care at low, upfront pricing. More please!

[@simonnachreiner8380]

Dude literally have the same thing it’s awesome!

[@TheMadHatter626]

There needs to be a love button. I absolutely love your work.

[@pompshuffle562]

Wow I never thought about this, I honestly couldn't think up a way to fix American healthcare

[@St33lStrife]

It's an absolute bear of an issue. There's a reason why, even though I've got the training and certification, and I've worked on plenty of patients, I've stepped away from the emergency medical field. I'm tired of people rejecting my services because they're worried about bills when we have charity systems in place as well as payment assistance and then others with nothing wrong who have state insurance taking advantage of ambulances for every nick and bruise. Entire system is broken. Which is why I don't work in it anymore.

[@colmlooney5843]

I don't blame you, if you are actually buying into any of this crap

[@Demonic_Culture_Nut]

Oklahoma has the most transparent healthcare industry in the United States and the cheapest healthcare costs among the same dataset.

[@noahremnek3615]

I went to the surgery center of Oklahoma. They are awesome I love dr. Keith smith.

[@alan-michaelhowells740]

I literally broke my wrist and didn't go to the hospital, fractured my elbow and didn't go, cut my fingers and hand pretty deep and didn't go. Not because I can take care of it myself, but because of how much it'll cost. 5 bucks at CVS on bandage wrap..or 2000 dollars at the hospital.

[@ohsweetmystery]

Me, too and I also have put back my own dislocated shoulder. I'm perfectly healthy and happy with how things have turned out. Most medical visits are completely unnecessary.

[@punkdrunkmonk824]

When I was 19 had a ingrown toe nail on my big toe. The doctor numb my foot, slicked part of the nail, pulled it out, wrapped it up in less then 10mins. Cost me $220 without insurance.

[@colmlooney5843]

Moral of the story, don't let your toenail get to such a state. Yikers

[@punkdrunkmonk824]

@@colmlooney5843 didnt know it was ingrown until i smashed it. the nail puncher the skin and kept growing.

[@colmlooney5843]

@@punkdrunkmonk824 oof, that's unlucky

[@michellemarie1197]

Our healthcare system here in America isn't perfect but I'm glad it isn't like it is in places like Canada in Quebec their free clinics aren't open on Sundays and a private clinic for something that is mild/moderate is $900 if you pay out of pocket, but in my hometown here in nebraska we have a small private clinic called quick care that's a walk in and you can just pay $50 down and then they will bill you and it's fast without waiting. I also need to mention that support staff also help bridge the waiting gaps for hospital visits and doctors offices (surgical techs, receptionists, medical assistant, dental assistants/hygienic, nurses and nurse practitioners etc) under socialized Healthcare you wouldn't have those support staff because the government can only afford so much and would create longer wait times and would have limited job openings for anyone wanting to work in healthcare.

[@snakyjake9]

Great video, but the sad thing here is that this only hits the tip of the iceberg. The market distortions in US Healthcare would take hours to properly deconstruct. We need a full length documentary of clips like this.

[@thepiratepenguin4465]

Thank God we have Nationalized health care in my country. I was evolved in horrible accident in 2017, which resulted in a me being in a comma for 8 days, as well as having a cracked skull as well as broke collarbone & arm. My total say in hospital was 22 days after 2 surgeries. I all so received 30 day physical therapy & it cost me nothing. How much would that have cost in the US?

[@jaykay5142]

You would have been instantly bankrupted, I fear. It's only about making the most money

[@STB-jh7od]

Love the comparison between medical vouchers and food stamps, never thought of that.

[@jasonw2696]

❤️❤️❤️ Truth bomb 💣! So the moral of the story is anything the government and the bureaucrats touch turns to shit! FJB!

[@VictoriousWatchman]

I appreciate the irony of a piece of paper getting a paper cut. 😂

[@brianh2253]

I worked as a nurse for 10 years. I do NOT have a single example of where I can tell you what ANYONE was charged for any service or medication that I gave or preformed. Not one. No clue.

[@curtbalch2321]

Most hospital networks have no process in place for sharing service prices with department administrators or staff, let alone patients. I managed half a dozen urgent care clinics for a large regional hospital and fought constantly to get pricing data on services as a function of charges versus actual fees collected from insurance. Instead the network would prefer to bill the uninsured/declined the full illusory charge instead of the 80-90% insurance discounted rate they accepted every day from carriers. Fortunately I was able to write-down charges for patients that complained, but even that was based on what I thought I could "get by" accounting rather than any reasoned charge. A few pioneering hospital networks have worked out their costing models, but the vast majority have their heads in the sand.

[@johngerring2505]

Broker here. Here’s the health insurance industries dirty little secret: Insurance companies’ business model is to drive the cost of Healthcare UP, not down. Why? Because the affordable care act mandates that the carriers can keep only a percentage of the total amount they pay out in claims. This essentially makes the ordinary business model of insurers(keeping costs down and eliminating waste and abuse in healthcare) completely irrelevant. Each year, insurance companies set goals for how much they will successfully drive up the cost of healthcare, and they set their premiums such that they collect 15 percent more than what they pay out. The more expensive the care, the more the companies make.

[@kdbublitz88]

I've heard this a little more than a year ago and as soon as I did, it made more sense than anything. There are actually movements of doctors going off of insurance and listing their prices for services like a menu at a restaurant. I wish we could get a itemized list like that of the taxes we pay too.. Also should mention that Healthcare has a lot of regulations and red tape which prevents competitive competing markets from driving down prices and innovation.. which idk if we would ever get rid of completely bc ppl's health are on the line, but maybe we can find out where there is poverty regulating and scale it back.

[@jaimeabengoechea8463]

Y does NOBODY compare how we treat healthcare to the food industry? It proves that needed resources can become super affordable and even special cases can get whatever food they need. A Tiny public option also exists for special cases almost nobody goes hungry

[@pfuiteufel1385]

That's a good point, actually. Never thought of that. But you could make the case that a surgery or chemotherapy - if necessary - is much more expensive than food.

[@cacacacacacacaca4389]

Soo right

[@jordanneal576]

We've turned health insurance into a health subscription service. Which completely defeats the point in insurance. This video is dead on.

[@Gottaculat]

It's just like how government financial aid programs have made college tuition skyrocket over the years. Whenever you stick someone else with the bill, prices and spending get outta hand. Come to think of it, that's why our country is in trillions of dollars of debt. It's super easy to be wasteful with other people's money.

[@caster863]

Why not let the states decide. The individual states should have power over this than the federal government.

[@MrBthomp]

I literally paid $600 for a doctor to slap my back and a bottle of ibuprofen

[@rickybobby6028]

Feature of capitalism = medical innovations tested on rich people.

[@colerulz13]

So basically because most hospitals (if not all) are private practice in the US so, they should act like a private sector and advertise their costs so, it'll help drive a better and more affordable market? Well why not? Knowing demand for such things would drive that narrative

[@m_d1905]

Lots of places have only one medical system to go to. That makes a monopoly and there is no competition. In my town it's all Trinity Health, with a couple of federally qualified health centers (clinic type providers who see the bulk of state insured (Medicaid)). So you are basically going to another town if you don't like Trinity.

[@colerulz13]

@@m_d1905 yeah I'm just an outsider looking in so really I don't have an water to my statement

[@shorewall]

It's supply and demand. The demand for health care is great, so we need to increase the supply of health care workers and doctors. Nurses should be empowered to deal with most issues.

[@AshnSilvercorp]

the problem started when healthcare was the same as insurance.

[@justinnewcomb2279]

My simple solution was joining the Army. Wait times are abysmal, Quality is lacking and I usually shoved from room to room/building to building, and I end up in a lot of pain after the procedures. But I’m used to waiting and long formations, spending ours doing needless cleaning and paperwork on top of paperwork, and Embracing physical pain from FTX’s. But hey my wisdom teeth removal was free.

[@pftburchell5197]

Anyone else remember when Trump tried to make hospitals show their pricing? What ever happened to that, did our representatives vote against it?

[@VTOffRoadAdventures]

It’s a thing. I called my local hospital yesterday and got answers in minutes. Because of how things are coded though and variations due to procedures having combinations or codes exact pricing is hard to determine, but I was able to get a usable ballpark value.

[@Ariel_Alpaca]

Bob is getting smart day by day

[@lolwtnick4362]

hmm great point. my grandma pays for meds every month and right around March and April the price doubles.

[@supanerdreviews4056]

Another thing about the pricing in healthcare is that it’s almost entirely fake or random. Back in the day healthcare providers would usually just charge a patient based on the treatment given and the equipment that was used with a little extra tacked on so they can still make a profit. It was simple but effective until the insurance companies came in and wanted a cut for themselves. They wanted large discounts on the services provided which would’ve driven most of these providers bankrupt. So what they did is artificially inflate the prices of their goods and services and gave the insurance companies a discount on the newly inflated price. Another problem with this is the pricing was never consistent between providers. A wheelchair at one provider can cost extensively more at another provider because of the insurance companies they’re affiliated with. And in a life threatening situation you can’t always tell an ambulance driver to take you to a hospital that takes your insurance. So they can go to whichever one is closest but it’ll cost you more money if they don’t align with your insurance. And even more disturbing is that each hospital has a detailed record of what their prices were inflated to and where they originally were. So they can at the very least stay consistent with themselves.

[@kaisermaximal8123]

This was more educational than the entirety of Southern California's colleges combined.

[@billyscenic5610]

Yeah Southern California can be a success of Louisanna and Mississippi!

[@junoguten]

Also the American Medical Association hasn't allowed universities to increase the number of med school spots since the 60's, while the available doctor hours per med school spot has decreased and the population has increased, aged, fattened, etc. Doctors have far too few hours to do their job with.

[@beware3586]

We should treat healthcare like a utility. Choose what you want covered (injury, illness, medication etc) then pay that hospital monthly and when you need care it’s covered. They get direct income and you get complete control over your care. Hospitals would also be incentivized to compete for your patronage. Meaning care and service are just as important as price.

[@db9944]

So you only pay for what you need.

[@josephk1342]

Yeah that's literally just health insurance dude, except if you're not near your local hospital, you're screwed.

[@beware3586]

@@josephk1342 But without the middle man... and all the regulation... and the fake pricing... and actual competition....

[@josephk1342]

@@beware3586 lol that's how insurance started out, and as it expands, it adds layers of complexity.

[@beware3586]

@@josephk1342 Thats the issue with insurance though isnt it? They are "fighting" on your behalf for your medical care, just like the government is "fighting" on your behalf to make insurance work harder for you. What im proposing is 100% between you and whichever utility you choose. This doesnt need to be so damned complicated. As for going to different hospitals or traveling etc, if you want them to cover a different hospital, add it to your policy. You should be able to negotiate on your own behalf and hospitals should be incentivized to be transparent in how they are pricing you and what you are getting for that service.

[@calebfielding6352]

In the U.S. its in the best interest of the insurance companies to keep prices as high as possible.

[@silverousleonidas5790]

Animation got upgraded. Nice!

[@chasemartin4450]

This sums up the solution to America's healthcare issues PERFECTLY!

[@goldengriffon]

Great job, but you're missing the part where those in control WANT things to "work" this way. There's far too much money to be made - and political points to score - in perpetuating a broken system. Removing the source of a headache isn't nearly as profitable as selling someone aspirin for the rest of their life.

[@jameswallace9906]

This will never happen. Half the country doesn’t want the financial responsibility needed to implement this.

[@BronyumHexofloride]

and then you look over at the UK where our healthcare system is funded by the government through taxation... it introduces an issue we call... the "Postcode-Lottery" where goods/services may be easier and better quality for some in one area and worse in others you may live in the best area to deal with Cancer but you may not be in the best area for dealing with broken bones and lucky you, you have a fractured skull

[@FuddlyDud]

Yikes, that’s a frightening prospect :/

[@musmodtos]

Yes, also as a Brit please don't fall for the _miracle_ of socialised healthcare. The NHS has a lot of serious shortcomings due to the model, and this is one of them. Due to the burdensome and overly complicated way the NHS is delivered to us a postcode (zip code?) may limit or not even offer certain treatments somebody paying an identical tax amount a few miles away may be entitled to. With our system there is nothing you can do about it really, it is often solely just based on your address and nothing more. It's more common with novel or very expensive treatments and is an unusual but far from rare occurrence. _Free_ healthcare that costs hundreds of pounds a month... Most healthcare systems aren't a quazi-religion like the NHS either...

[@FuddlyDud]

@@musmodtos Yikes, that is a great point to be wary of government controlling your healthcare. :/ Hmmmm, maybe we could just socialize preventative measures and leave the treatments/urgent care for after the fact costs? Maybe this would help fix the actual issue, especially of the US, of living unhealthy lives. :/

[@realstatistician]

He touched on one additional thing at the end. He wouldn’t be able to start his own clinic without licenses. The medical schools have constructed a massive barrier to entry into the medical profession to inflate the value of their services via the difficulty of completing the education (12 years) to get licenses. An urgent care physician who sees the same 20 problems 99% of the time has to complete at least 12 YEARS of education+residency to be able to tell you to go see a specialist.

[@donovanbryant1874]

I live for this series

[@BarnJ]

Free-market solution: complicated but would actually work. Leftist solution: would be catastrophic but easily fits on a bumper sticker. Every time. For every issue.

[@No-qu4ro]

Free market solution would actually work they already tried the free market approach on internet and that turned out terrible. This is how it would actually work. U would get worst treatment for what u pay right now. U would pay more for the treatment u get right now that simple they make bad healthcare for the poor. Descent healthcare for the middle class and good healthcare for the rich. All the middle class workers will have poor healthcare. We say the same thing with the internet in America. They will make a fast lane and a slow lane if u are poor u get put in the slow lane for healthcare worst treatment for what y have right now for a higher price. Did we not learn what happens when u don’t regulate business look at the threat depression and the Great Recession.

[@riffraff3467]

Yes whats happening in america is the free market solution lol. Almost every oecd nation has government healthcare for all its citizens. America has no price controls so the private companies can literally set the price to whatever the fuck they want. Look up the price of insulin in america vs other countries. That shit is so so cheap to produce.

[@nicolasleroux5302]

If the free market were the solution, we wouldn’t have the most expensive drug and surgery prices on the planet.

[@BarnJ]

@@riffraff3467 ...it's not a free market when the demand side of the equation has no idea how much they're paying until services have been rendered and the actual cost is usually paid for by an abstract and compulsory third party (the insurance company your employer selects for you).

[@nicolasleroux5302]

@@BarnJ Monopolization is the inevitable result of the free market. That’s why there are half a dozen major entertainment companies, social media companies, ISPs, news media outlets, and health insurance companies that dominate their respective industries.

[@iloveyoushima]

It’s worth mentioning that even rightwing European and Asian countries make a socialised healthcare system work.

[@t3hfluff]

people who don't care about their health should be exempt. Im a doctor and nothing like bad patients blaming me for their poor habits

[@wert1234576]

I got messed up real bad once and had to have reconstructive surgery now at the time I was a full time student and part time worker so when I was sent a bill of 20k I figured I was fucked but I talked to the hospital and basically they had me prove I couldn't pay the bill and they wrote off most of it off, since that day I have had an issue with hospitals because if they can just drop the price then why don't they? Idk but its bull.

[@dizzthenibbler4070]

I've been against healthcare for decades, but, I have always left myself open to the discussion due to the prices hospitals charge. I've said for awhile now we need price regulations on that crap. A saline drip shouldn't cost $300 when the supplies only cost like $20. And the time and labor shouldn't be $280. It isn't hard. Edit: against free healthcare*

[@skotttownzend5170]

I love common sense soap box, bringing common sense to those who lack it and reminding those who do why its useful.

[@nimisisblademedia866]

I like the idea but I would also say some regulations to help health care from becoming to corporate.

[@jfwfreo]

I don't know a lot about the US healthcare system but from what I do know I can nominate some things that would improve the situation: 1.Eliminate certificates of need and all other restrictions that artificially limit competition between healthcare providers (e.g. someone who has the appropriate licenses/qualifications and wants to provide free or discounted services to those worse off or wants to set up an MRI machine or similar but is blocked from doing so) 2.Reform the insurance system. No more HMOs, corporate health plans etc and no more restrictions that get in the way of competition in regards to insurance. Health insurance should be like car insurance or house insurance where there are a whole bunch of providers out there offering different policies (e.g. one policy might have cover for optical and eyeglasses while another cheaper one might not or one might give coverage for a private room in a hospital and another cheaper one might only give coverage for a shared room) and individuals pick and choose what policy they want based on price, services offered etc. 3.Except for situations where it is impossible to do so (e.g. emergencies, people who are unconscious etc) or where the price genuinely can't be identified in advance due to not knowing exactly what services/treatment are required, patients must be told the full price before they get treated and have the ability to say no to the treatment if the costs are too high. This would include being told how much the insurance company will cover (if anything) and what they have to pay out-of-pocket. Once a price is set, the provider can't turn around and charge more unless services not initially listed on the up-front price schedule. This would also obviously cover drugs, medical equipment and other things as well. 4.Ban the advertising of prescription drugs or other prescription products. Make it illegal for producers of products (drug companies etc) to provide incentives to practitioners (doctors etc) who push or prescribe those products. More generally take away incentives for doctors/hospitals to push un-necessary drugs, tests, treatments etc. and 5.Eliminate the relationship between insurers and providers. No more "sorry, we wont pay out on that because the guy who treated you isn't 'in network' or the ambulance took you to the wrong hospital". For essential necessary treatment (at the very least) insurers shouldn't be allowed to discriminate based on where you go (they can say "that guy costs more but we pay the same so you have a higher out-of-pocket" though)

[@carlthelongshoreman1979]

Ah yes i would love to get care from someone WHO ISNT TRAINED

[@jfwfreo]

@@carlthelongshoreman1979 Nowhere did I suggest that someone without the appropriate licenses should be able to practice healthcare, simply that artificial limits that prevent someone who does have the necessary licenses from offering a particular service or opening a particular facility be removed.

[@trevorpettet7649]

why can’t we just eliminate the private insurance company between you and your doctor

[@harbingertheheretic3541]

*Insurance* is a hedge against future risk. Today's American "healthcare plans" are not insurance. Look at the difference between healthcare plans and car insurance. Car insurance doesn't pay for routine maintenance, or for problems like the A/C switch that crapped out on my car last week. Granted, car insurance is high these days with the rising cost of cars, but you get the point. If we want to lower costs, then we first need to repeal the ban on "catastrophic coverage" plans that are actual insurance. Unfortunately, that is a part of 0bamacare, so any attempt to change it will be met with emotional "you want everyone to die or go broke" screams from the 2/3 of the country who don't understand even the basics of economics. And I can't afford (yet) to send them all copies of Thomas Sowell's book _Basic Economics._

[@CigaretteCrayon]

@@harbingertheheretic3541 2/3 of the eligible voters aren't on the Left, just saying.

[@josephreagan9545]

There is a hospital in Texas that will only take cash payments and it is cheaper than average.

[@HankRearden84]

Post coof, one can't even trust the hospital janitor let alone the doctors.

[@logicalsatire6043]

2:40 When urgent care is needed, separate the healthcare market. Because of how urgent care facilities (UCFs) work, where you go in an emergency depends on location. As such each hospital ends up becoming a monopoly and choosing between them becomes very dangerous. I wouldn't mind publically funding UCFs and letting the free market take care of everything that's not really urgent. To me that's a good compromise between both sides

[@ohsweetmystery]

But who decides what is urgent care? Do people with non-urgent needs get charged if they use services at a publicly funded UCF? I agree with immediately life-threatening issues like heart attacks, severe accidents, and gunshot wounds being urgent, but not most broken limbs, minor flesh wounds, toothaches, etc. I've seen people go in to urgent care for things that I find absolutely ridiculous.

[@logicalsatire6043]

@@ohsweetmystery exactly. We need to establish a line where a hospital is urgent only. If you don't have a life threatening condition you don't go there. It's gonna take a change in people's minds tho

[@PAcifisti]

US doesn't have a scarcity issue with healthcare, just private market issues. Who knew when you let rich people profit off the health of everyone they're gonna jack the prices up to ridiculous levels.

[@athrunzala798]

The company i work for does clinical reviews to ensure that procedures like CTs, pacemakers, etc is clinically appropriate for the safety and cost of the patient. Its wild how much some doctors/hospitals over order. Also freestanding facilities cost way less than a hospital for the same scan like a CT (obviously depending on the type of procedure)

[@maliksmith9003]

One problem: when the hospitals come together to artificially increase the prices of services so that no matter where you go you'll still get ripped off (not unlike the housing market), then what?

[@vietta6424]

When no one is able to afford care, do you really think that the hospitals will be making a profit? Of course not, the hospitals have an interest in making the price affordable enough so that they can make a profit but not so much that no one can pay to use it. Also, hospitals have no reason to cooperate, if one increase prices then the other is directly benefiting.

[@vietta6424]

Basically, higher prices doesn't mean higher profit, even if the care is life threatening, if you can't afford it you can't use it. That's money that could have been made if prices weren't high, being thrown down the drain, no sane company would ever consider that.

[@conscript900]

Ive been very fortunate to have good doctors over the years, My biggest issues usually been insurance companies trying to get in the way of the care i actually need. Like recently they wanted to try and switch me from IV infusions to a pill (xelganz specifically in this case) and i suffered every side effect except death and i think one other XD. Didnt take long for that to stop but seriously not only do i think we need to maybe lean more into looking at how to fix issues like this but fix the issues of insurances that are there getting in the way of the care of the patient when it actually does make a critical difference.

[@vinceknowseverything]

One Be-half of Everyone who has gotten a papercut... I am sorry for you.

[@Br3ttM]

You can still have patients with insurance consider the cost if you have percentage based copays. Put in some scaling, so small things have high percentages, and major things have small percentages, and people won't completely ignore small things like clinic visits, but also won't go broke just from the copay on a major surgery.

[@dww6]

You might actually find that a single nationalised healthcare provider free at the point of use is good for driving down prices because of the combined buying power. It also drives down the cost of private treatments because they have to compete with "wait and it's free".

[@m_d1905]

There is a big problem with "wait a d it's free" approach. Many issues become worse with time, not better. Deferring treatment is a very bad idea.

[@dww6]

@@m_d1905 it's not perfect but it beats saving your life so that you can die in poverty and for coat effectiveness it's amazing (The UK government spends less per capita on healthcare than the USA). Prior to covid waits weren't terrible (unless you were after complex T & O surgery) I can Normally see a GP same day.

[@OGPepsiman]

Everytime I get a notification, I learn a lot more after I’m finished watching it!

[@mikeoxlong7844]

First

[@glennschmidt3445]

Rewatching a lot of these should have also mentioned the whole we are limiting how many doctors there are and forcing doctors to be limited supply so each doctors time is more valuable and raising the price that way also

[@briannafahringer1738]

First :)

[@shadowsa2b]

I like how you acknowledged the paper style and had bob crumple up. Ive been saying for some time that more open competition in medicine would help to bring costs down. Our current employer/insurance company structure is basically just a series of monopolies that discourage innovation and only place disruptive limits on treatment and pricing. The doctor gets payed either way, so thats a win-win there. Same for the insurance company middle man who is given power to deny you necessary medical care if its not profitable enough for them; which is very perverse. The conversation should instead be about how to make healthcare itself more affordable, rather than about whos going to pay that stagnant high costs that insurance companies maintain. The ACA did nothing to that end

[@ratcalaf]

The free market does not encourage entrepreneurship, it encourages monopolies (This is in reference to necessary services/goods, hospitals, food, transport, etc.)

[@ExPwner]

No it doesn’t. The free market does not create monopolies and it does create entrepreneurship.