Medicare for All vs. Swiss Healthcare System


It’s great to welcome to the program today,
Dr. Aaron Carroll, who’s a professor, pediatrics at Indiana university school of
medicine and the Regan Streif Institute. I hope I’m pronouncing that correctly, who
writes about health research and policy at the New York times and his blog, the incidental
economist and has a YouTube show on these topics called healthcare triage. So great to have you on today. Thanks for Ambien. So let’s start our conversation about evaluating
different systems of health care and paying for healthcare. Maybe by establishing how we would measure
how well a system functions, what are the key things that we should be thinking about? Are they a of care quality of care and outcomes? The cost per capita, like how do we even establish
the guidelines for figuring this out? So we care about all of those things. So whenever we talk about a healthcare system
or any kind of healthcare forum, I always like to, to frame it in terms of what some
people refer to as the iron triangle, but there are three aspects of a healthcare system. You always need to think about how much does
it cost, what’s its access, like how is it, is it cow, can you get the stuff that you
want or need? And then what is the quality that it produces? What makes it an iron triangle is that you
can make any one, maybe two of those things better, but it often comes at the expense
of the third. I can make a system that’s cheaper tomorrow,
but then probably it’s either going to be less quality or there won’t be as much of
it. I can make a system universal tomorrow, meaning
everybody can have everything they want. Again, that’s going to cost more or probably
quality of suffering and I can give you the best system in the world, but then again that’s
going to cost money or you know, access is going to suffer in some way. So the problem is that we are always looking
for a silver bullet that does all three of those things at the same time. It’s just not going to happen. So most healthcare form that we want to consider,
we have to say, what are we trying to achieve and what are we willing to give up in order
to get there? What are the trade offs? We don’t engage in that. Now, within those three domains, there’s lots
of ways to measure a healthcare system with respect to cost. Is it public costs or private costs? How much is out of pocket? How much are premiums, how much, uh, would
you still have to pay? Even after that, how much would come out of
taxes? It gets very complicated, but the United States
is an incredibly expensive system no matter how you’re breaking. Yeah. I want to get to that in a second. I mean, one of the things that I recently
read a UIE Reinhart’s latest book where he, when he talks about the cost, he says something
which makes sense, but I think is often not in the conversation that happens at least
in the media about health healthcare, which is that as you point out, there is some total
cost and that can go up or down. What is the total cost to treat the average
person in a year? And then oftentimes what we’re really debating
is actually how should that total cost be divided from the population. In other words, should we tax Richard people
more in order to pay or, or so on and so forth. Is that a part of the discussion that is maybe
not spoken about in those clear terms? Sometimes. I think it’s part of, but it’s not even all
of it. Uh, you know, part of it is that we think
we have a very, uh, private system and we do compare it to some countries, but still
about two thirds of healthcare spending in the United States is what we would consider
not private. It’s public, meaning that it’s, it’s Medicare,
it’s Medicaid, all of what your taxpayer were. Some other way, you know, government run. It’s the VA, it’s everyone that works for
a public institution but has private insurance. Like me, I work for Indiana university. It’s a state, you’re all paying my salary
and taxes. You’re all paying my health insurance. Even though I have private health insurance. It’s public taxpayer money, which is paying
for it. And Charlie, when you add all that up, it’s
like two thirds of healthcare spending is already publicly finance in the United States. That’s almost more per person than any other
country pays total. And then on top of that, we still feel like
we’re all privately paying way too much money for premiums that our jobs and even on top
of that, we feel like a pen, way too much money out of pocket when it comes to copays
and deductibles. So no matter which way you want to measure
how we’re spending, what the cost of care is in the United States, it’s, it’s just unbelievably
high. Especially, I mean, Uber would be the first
person to tell you, um, you know, rest his soul. But, but it’s the prices. It’s, it’s not even just how much are we consuming,
but it costs more per unit in the United States than anywhere else you could possibly imagine. And so our costs are just through the roof
and as, and of course everybody wants that to be less or lower, but you can’t do that
without sacrificing access or quality likely in some way. So let’s get into this again, because it’s
so much of our economy and if the drastically reduced healthcare spending tomorrow, we would
instantly be in recession and or a depression. Yeah. So, so that’s another really interesting thing
from Reinhardt’s book where he says, if you actually read, you know, spending in healthcare
is jobs in a very practical sense. And we have this idea that if we reduce spending
but get rid of extraneous things like medical billing and insurance fraud investigations,
that it’s all okay. Some people will have to find new jobs, but
there is a very direct link between total healthcare spending and employment. Oh, Oh, well. Again, it’s like we’re not, when we say waste,
it’s not money that we put in a pile and burn. Um, all of that waste is another person’s
income. It’s, it’s, you know, it’s paying for stuff
and people and jobs and not even just, you know, drugs. But the people that work at the drug company,
the people that clean the offices that the drug company, the people that pave the lots
outside of the drug, it’s, it’s 16, 17, 18% of GDP in the United States. Meaning about what one seventh, one eighth
of our economy is healthcare. If you say tomorrow, let’s instead of spending
18%, let’s spend 16%. We just dropped GDP by two percentage points. We ended up depression. Those lines. My, you know, I am, uh, I believe Medicare
for all would be a much better system than the one we have. At the same time, I have looked into enough
of the specific propo proposals that I see what may be a problem with some of the plans
for how to pay for it. And I want to see if you agree with me or
where maybe I’m getting this wrong. It seems to me that most of these plans assume
in order to make the numbers work a drastic reduction reduction in healthcare spending
per capita in the United States. That would put us, depending on the plan that
you look at in line with maybe Canada or Australia and I have not seen a good defense of how
that’s going to happen. Aside from whether it would be good or bad,
we can debate that part. I understand that if you eliminate some of
the quote waste from the multi insurance billing system in different things, you’ll reduce
cost a little bit, but I don’t see how it gets reduced so much. Is that a fair critique of some of the plans
for how to pay for it or am I maybe missing something of some of it? Yes, but I would say it’s even, it’s even
a little more complicated than that because again, I would turn up, I’ve been in terms
of trade offs like we were at the beginning. So single payer healthcare, which is what
Medicare for all is a perfectly viable way to improve access. That’s what it would do. It would get us to universal. So at that point they’d say, well, what’s
the trade off? Are we going to sacrifice quality or are we
going to sacrifice? We’re going to spend more money and we could
absolutely spend more money and then everything would be fine. But if we’re not, then we have to say, well
then what will the trade off be if we’re going to significantly reduce spending at the same
time that we’re massively increasing access to imagine the quality has to suffer in some
way. But the broader picture is exactly what you
said. Like there’s no magic to this single payer. Healthcare systems are not inherently cheap. They’re cheap because they can use their single
payer market power to force every provider and purveyor of healthcare to accept lower
reimbursement. Um, and so that’s where the magic comes in. Medicare often reimburses less than private
insurance because they just have all the patients and they can turn to providers and say, we’ve
got all these patients. If you want to make a living, you have to
accept the insurance the way that is. Theoretically, if everyone was on Medicare,
then the governor would have enormous power to say, everyone’s going to have to accept
less reimbursement. That’s how it’s all going to function. Well there are trade offs to that, be it their
innovation, be it through what people are willing or able to provide. The idea that everyone is going to continue
to operate at peak performance for less money is not realistic. And again, we can say, Oh well we’ll just
take it out of fraud and waste. That’s still somebody’s income. That’s still somebody working. There’s no magic solution. So Medicare for all is a perfectly viable
way to achieve universal coverage and theoretically to put use market power to reduce overall
healthcare spending. But there’s got to be trade offs. So now a defender of the Medicare for all
system would hear you talking about that and say, well, there’s a combination of things
there that would go into this. On the one hand, uh, there is a stimulative
even though, yes, a reduction in total cost is a reduction in jobs, the stimulative effect
for all of the end users who no longer are spending as much money out of pocket. If you believe those estimates and also are
not at risk of a bankruptcy because of unpredictable healthcare spending, all of that money is
going to have a much more stimulative effect being spent at businesses, for example, that
will increase government revenues and therefore it’s all sort of going to work out in the
end in a way that is relatively neat and tidy. Or what do you think about that? I think it will work out at the end, but I
think it’s because Americans have no appetite for cost control. I think what would happen is that we’d Pat,
if we pass a Medicare for all, what would happen is the system would just cost much,
much, much more money. Um, because we could theoretically use this
market power that we have in Medicare right now to curtail or hold down Medicare spending
and we don’t. Um, the government just keeps spending more
and more on Medicare to where you have politicians arguing Medicare is going to go bankrupt and
spending too much and no one does anything. That’s what I think would happen in the whole
system when I read the analysis. It seems as though the access piece may well
be as it’s expected to be. The quality of care piece, if managed correctly,
may well be. It seems that it’s just going to cost more
than most of the plans are accounting for. And maybe now, maybe that’s okay as, as a
decision that a country can make. And that’s, that’s where it’s like if somebody
said to me like, well, then what would you, it’s like, I believe we have a plenty of appetite
to spend a fortune on healthcare given that there are better ways to do this that would
provide higher quality and better access for the enormous amount of money we seem willing
to spend. Um, I think deep in people’s hearts, that’s
where Medicare for all would wind up if it was passed, is that it would achieve universal
access. Um, in order to avoid real problems in quality,
we would just keep spending more and more and more money because we have no appetite
to say no. It would just not hit the budget projections
that people think. And then how would we pay for that? I think likely if, if someone actually had
the political power to get Medicare for all through, it would be on the backs of things
like wealth taxes, um, and trying to to squeeze more money out of the, the people at the very
high end part of it. There’s also this, this political reality
where there’s never a question of how do we pay for this war or those weapons, but it’s
a debate here and I think that that’s a reasonable critique. Yeah. And I think that that’s, I think that’s why
if Medicare for all was to pass, that’s how it would work. It would be, it would just be very, very expensive. I don’t think we have much of an appetite
for saying no to individuals for healthcare stuff that they have, no matter if it works
or not. I don’t think we have much of an appetite
for, for really impinging people’s ability to get what they want in terms of access as
quickly as they want. Um, nor are we going to suffer much in terms
of quality decline. So we’ll just spend a lot and we’ve been doing
it for a long time and that’s what we would do. And I think the arguments would be if it were
to pass exactly what you said, that we don’t seem to worry about how much the war cost
or, or how much the tax cut costs. Why are you all screaming about how much the
healthcare costs? Everyone’s getting it, they’re feeling better
about it. Let’s just spend a ton of money now. If, if it were just up to you, because you’ve
looked at so many systems, you’ve looked at European systems, there’s the system in Singapore,
which we’ve talked about before, which is very interesting. Do you find that there is some other system
that might be better suited for the United States specifically? So this is what we’re about. Two and a half years ago, we did this thing
at the New York times where we actually, uh, we picked eight countries, healthcare systems,
and we had a tournament, like did a bracket and let both experts and the public vote. Um, and in the end it came down to a, uh,
a battle between France and Switzerland and Switzerland won. And I think that’s a reasonable call. Switzerland has a healthcare system which
is universal, um, and it is entirely private. There is no Medicare or Medicaid ish kind
of thing. It’s entirely private, well-regulated, mostly
nonprofit, uh, health insurance not coupled to jobs from birth to death, from with a sliding
scale subsidy for those of the low end of socioeconomic spectrum. So subsidies to help people buy it, they achieve
remarkable outcomes. They have pretty high levels of cost sharing,
which we seem to believe in. Um, and their costs are high compared to most
of the world, but not to us. Um, and, and it’s great and it’s again, it’s
entirely private. Um, there was a plan not that long ago, perhaps
a little more than a decade ago. It’s called widen Bennett. Um, it was Ron Wyden who’s a Democrat from
Oregon and it was a bill Bennett, uh, who was a Republican from Utah. So it was a totally bipartisan plan and they
had co-signers from both sides of the aisle. And it was this, it was birth to death exchange,
like insurance, totally private with subsidies or tax credits, uncouple it from jobs, very
Switzerland. Like there was a time in the United States
when now would, would’ve been the good compromise solution. Um, but in the heat of the ACA and all the
political ramifications and partisanship, it got crushed. Bennett got run out of office. Um, no one will touch that. But I personally think that there’s probably
more of an appetite for that kind of tightly regulated private insurance that could be
marketed as a compromise ish type solution for America that would still allow for, you
know, still not government running it as much as say a Medicare for all would be an a perfectly
viable way to, to to achieve universal acts. That’s actually both. Both the French and Swiss systems are ones
that, ones that we’ve talked about extensively. Interesting. Interesting to hear that. We’ve been speaking with Dr. Aaron Carroll,
who’s a professor of pediatrics at Indiana university school of medicine. Make sure to check out his YouTube program
on these topics called health care triage. Thank you so much for your time. I really appreciate it. Anytime

100 thoughts on “Medicare for All vs. Swiss Healthcare System

  1. Thank you for covering this topic! Married to a pediatrician who loves Bernie but is skeptical about what happens on the doctors end of Medicare for all. Hey…if you want to interview another pediatrician contact me!!

  2. The doctor is a moron
    As soon as you hear the term" cost"
    You are a idiot
    The real was question is
    Do we have the knowledge and resources
    Obviously no such thing as freewill
    https://youtu.be/MhieXHKslTs

  3. where's the excessive profits factor?
    What controls are in place that keep the Swiss system from becoming susceptible to greed and corruption? Something lacking in the US?
    This discussion was weak on actual information and seemed to have too many unsupported assertions.

  4. Times American Healthcare System Shocked The Rest Of The World: https://www.youtube.com/watch?v=sOsqXxFZVMA&t=1s

    Healthcare costs per country: https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita#/media/File:OECD_health_expenditure_per_capita_by_country.svg

    Healthcare quality per country: http://thepatientfactor.com/canadian-health-care-information/world-health-organizations-ranking-of-the-worlds-health-systems/

    The myth of way higher taxes in other countries: https://howmuch.net/articles/money-people-take-home-after-taxes

  5. Aug 7, 2018 · Buckminster Fuller described the idea of ephemeralization: “Do more and more with less and less until eventually you can do everything with nothing.”
    de·ma·te·ri·al·ize

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    Learn to pronounce

    verb

    become free of physical substance; cease to have material character or qualities.

    "the kiss dematerializes into a kind of spiritual rebirth"

    (in science fiction) disappear or cease to be physically present through some imagined technological process.

    "he watched the time machine dematerialize"

    replace (physical records or certificates) with a paperless computerized system.
    Cyberhyperian inc.
    https://youtu.be/dxqc-QDVPws

  6. ITS THE QUANTUM COMPUTER AGE: ELIMINATE THE STAFF FAT, COPIOUS ADVERTISING TONNAGE, LOBBYISTS, PHARM BS COSTS, AND NO COMPETITIVE PRICING!! END FATASS AMERICA: PHYSICAL FITNESS BEGINS IN GRADE SCHL EVERY DAY, FAMILIES PLAY TOGETHER BUT NOT VIDEO GAMES; SODA ALCOHOL JUNK FOOD 50% TAX: GROW UP CAPITALIST INDULGENT IDIOTS!!!

  7. Haven't finished yet but I'm so happy you made this video, David. I used to be a supporter of full on single-payer single-provider healthcare like in the UK, but after reading about Switzerland's system it was hard to dispute how successful they've been. Thank you for sharing this perspective with your audience, I really respect your intellectual honesty with beliefs you may disagree with.

  8. Platform: Campusreform did a video 4 days ago that starts with students saying they support Medicare for all until a true deeper dive. I found it very interesting that for many that phrase is a blanket panacea; I look forward to quality debates once the field is narrowed because the last ones were useless

  9. And the 100 billion dollars in profits the health insurance industry sucked out last yr? We can't get that down? Can we at least place put a max income for those CEOs and executives???

  10. Medicare for All is just public funding of private institutions, which is basically the Canadian system. In other countries this would be considered the right wing system, the NHS (public funding of public institutions) would be considered the left wing system. The USA however… their Overton window has is far right that even the most basic ideas are considered far left.

  11. The problem with applying the iron triangle model in this case is that what we pay for healthcare in the US is much higher than what the healthcare costs. Last year the health insurance industry made over $20 billion in profits. That's "free money" for the purposes of adjusting the triangle. A further reduction of the gap between cost and price can be had by a single, sovereign entity negotiating rates. Currently there are multiple insurance companies negotiating with multiple providers, and anyone not insured pays artificially inflated prices.

    I don't know if this doctor just hasn't fully thought about all the issues that go into the cost-coverage-quality dynamic when comparing for-profit health insurance to government-provided health insurance or if he's being disingenuous, but his argument is flawed.

  12. I don't see where this guy justify American healthcare being twice as expensive as the Swiz one.

    Is the rate of healthcare cover higher in US? LOL!
    Is US healthcare better? Doubt it!
    Is wages and price of living higher in the US? Nah!

    It's not medical personal salaries and cost of care, that bring the price up in US, it's marketing and share-owner payouts

  13. Americans are not rich enough to have universal health care, there government is far too small to handle the job… Plus Americans adore poor people it makes them feel empowered.

  14. We always find the money for war no conversation necessary.
    When it's time to help people in our country all we hear is let's be practical how are we going to pay for this?

  15. Yea but just because it's a job doesn't justify anything. And not all jobs would be gone, new jobs would be created, the logistics doesn't just randomly happen, a lot of jobs would be created as well for getting people into the program.

  16. Innovation? Most innovation has been tax payer funded.

    And again, if someone had a job of killing people, then your arguement of "if we get rid of killing people, that person will lose his job" uh who cares?! Lol. It's not just or moral.

  17. Glad to see David and healthcare triage collab.
    Healthcare triage makes great objective video's on country's healthcare systems.
    And how the US system is a massive outlier.

  18. It seems like there's numerous flaws in his analysis. And in a way over simplification while also complicating it In the wrong areas.

    On the quality vs price vs access argument, we know for sure that price goes down as a result of numerous factors such as elimination of marketing costs, negotiations for prescription drugs and services (not necessarily correlated with lower wages for doctors which he seemed to imply here numerous times), dropping the need for medical billing and collections, eliminating the gigantic salaries and BILLIONS in profits every year that go to the private companies, their investors and ceos, etc. those alone save us 100's of billions a year- even by conservative estimate it was 200 billion per year.

    Regarding access, we also know that this same cost saving system absolutely and unequivocally will increase access to not only every person in America, but also allowing people to make a choice about the doctors and specialists they visit. It breaks the confines of "in network" insurance systems. It also won't be denying essential coverage, including life saving medications, important but expensive surgeries, etc. we eliminate insurance companies making more money by DENYING coverage. It seems pretty undeniable that access increases by exponential measures.

    Regarding quality – strictly by the numbers – more Americans getting the access to their medications, appointments, surgeries, preventative care, where they previously were unable to afford to will increase health outcomes overall and especially for poor and the working class communities all over this country. The argument that quality will go down doesn't add up either. Why would subtracting profit motives lower quality? The doctors, nurses, medical techs on average will be receiving the same salaries and they won't stop supplying MRI's or other services. In fact if anything there might be motivation to continue providing needed services as opposed to insurance run hospitals making money by providing less service or easier services where they make more. We also know through experience that even tho Americans spend way more, we don't have as good of quality as many other countries with single payer systems. And health outcome increases would play a big role in bringing the quality of healthcare up in America.

    On the issue of jobs… part of Bernie sanders Medicare for all plan will be the transition of those workers to other areas related to their work. They will receive up to 5 years of pay AND training – even for a new field if they wanted. So there is no way those people will be left behind. That's never been Bernie's style anyway. He would not leave those people out of the loop. And with the 4 year transition from Medicare covering 65+ as it does not, to 55+ to 45+ to 35+ and then everyone else, there is an easing into the financial upset that it will produce. And the fact that we can do all this cheaper than Obama care, cover everyone in America, increase health outcomes AND help pay and train anyone who is personally effected by this… there's really no reason we shouldn't fight like hell to get it done.

  19. do it and also do price controls for real estate and other housing; there is no great and compelling reasons to continue to continue to inflate our costs of living versus to follow the market; and we know that 'whatever the market will bear' and 'supply and demand' are rigged and don't work because these things are controlled by the same people that are too wealthy…but this is a sticky discussion and needs more talk but it better not be dropped or our youth will at some point say to hell with this and rebel

  20. Private and free market are not the same. And I agree with non profit healthcare system. The issue we have is a for profit system

  21. Resources are finite. Either the cost increases or the supply decreases. Not sure why people can’t get their minds around this. Free healthcare for everyone in a country of 300 million people can only result in rationing and yet the same people pushing for this are also advocating to import immigrants by the millions which only compounds the problem.

  22. I'm just saying , the Swiss health care system must be garbage because my girlfriend has lots of medical problems and she's a swiss citizen and her father rather have her in the U.S paying full cost of her medical bills of which is in the tens of thousands figure.

  23. If we can afford to spend what we do in our military and on the golf course with Trump, we should be able to have Medicare for all! This sounds like a Republican talking point. Talking about jobs, the people need to be alive to work! If they can’t afford healthcare they can’t work!

  24. Why the hell can’t it United nurses nationally
    wants healthcare for all nobody is fussing about the quality it should be equal
    Other countries don’t pay premiums
    They don’t have The middleman insurance
    Our taxes damn well pay for all of it!
    We pay for all the Congress and all the feds damn we’re all citizens everybody should have healthcare

  25. lol @ the idea of non profit private health insurance scheme working in America

    No private health insurance
    No sliding scale subsidies
    No tax credits
    Just healthcare

  26. People that grew up it lived overseas where Universial healthcare know that the American for profit healthcare is not the right thing to do

  27. Real lazy to not include a link to this dude's channel in the description. Yes, I can find it quickly by pasting his name or channel into the search, but c'mon … this is golden rule stuff.

  28. They got rid of steel companies they can get rid of the insurance companies they can reassign those people to other office jobs to sign people up to check on people to do the proper things about investigating paperwork

  29. It would be in line $ with candidate Yang’s thousand dollars a person and we can damn well afford it!
    How much as Trump wasted? We need to audit the government better on what we the people pay for and what we the people really get

  30. They can’t make a big profit on healthcare that’s not cool man it’s making me angry every time I hear another sentence we don’t need profit making healthcare companies deciding who lives or dies everybody should get the same good health care

  31. We have the appetite!!! the big healthcare companies and corporations do not have an appetite for Cost control GTFO
    Why can’t the government control cost they control time they control The laws! They control everything about our lives except what we need and cannot get
    they’re taking our money they can give us healthcare

  32. What percentage of people don't even go to the doctor because they cannot afford it? If ANYTHING, passing medicare for all would initially put money in healthcare provider's pockets because EVERYONE would now go to the doctor AND that sector would absolutely grow. Sorry but this discussion lacks all common sense. This is neoliberal bs. Unsubscribed, have no time for fake progressive, zionist outlets like this.

  33. Yeah "innovation", sure. Their latest breakthrough is a new even more powerful opioid (even stronger than fentanyl yet) that they plan to mass market to everyone not just extreme cases.

  34. U WANT BETTER HEALTH AND LESS DOCTOR/HOSPITAL CARE? DEMAND HEALTHIER FOODS! THE FOOD GIANT COMPANIES AND PRODUCERS ARE KILLING US WITH POISONED FOODS….BETTER FOODS AND ALL OTHER RELATED PRODUCTS = HEALTHIER PEOPLE. CLEAN AIR, CLEAN WATER etc etc etc.THE RABBIT HOLE GOES EVEN MORE DEEPER THEN THESE COMMENTS…. FAST FOODS etc etc etc. 👎👎👎👎👎👎

  35. im surprised to see corporate scare tactics on this channel less money for insurance exects and more for doctors and nurses

  36. This guy has some points (I've said that liberals in the US would kill jobs – like the 500 people who do paperwork at the boston general hospital, where a canadian equivalent had 2 guys).

    But the argument here is solving inefficiencies and covering more people (putting in an economy of scale) will somehow cost "more" is really weird. That's like saying going from 300 guys doing nails to 100 guys doing nails with the same output would somehow make the nails cost more.

    As he said, 2/3rds of medical coverage is via a public institution already.

  37. We make drugs illegal and punish the people who sell them because we say drugs are bad mkay? We also outlaw the world's oldest profession, for reasons, and its 2nd oldest (murder for hire). So we're obviously okay with saying some jobs shouldn't be how a person makes a living. Why not add claims "adjusters" and deniers to that list? The end result of their profession is often people going bankrupt or even dying because they cannot afford their meds. It's not as direct a death as murder for hire, but whose hands is the blood on?

  38. To contain healthcare costs in order to afford any system, we have to stop looking at healthcare as if it's in its own silo. Healthcare policy has to be looked at in the context of Ag and food policy plus campaign finance and government reform. Why? Currently Ag and food policy is largely shaped by industrial groups, especially by big food and pharmaceutical interests, so the government ends up subsidizing the very food making us all sick. For example, soda and processed foods full of sugar including corn syrup can be bought with SNAP coupons. A lot of current healthcare costs, especially for diabetes and obesity, are preventable simply through better lifestyle decisions like what foods people put on their plates. The government should be supporting regenerative grown produce and regeneratively raised meats…not industrial soybean and corn production used as ethanol, in processed foods and as feeds for livestock in confined feeding operations. If you don't take a more holistic view of healthcare, it really doesn't matter how it's funded since the burgeoning diabetes epidemic and the forthcoming degenerative brain disease epidemic is going to bankrupt whatever system is put in place.

  39. "High levels of cost sharing, which we seem to believe in" hmmm. I would rather have less of that if possible. Dunno who says "I want higher co-pays!"

  40. This missed the major point, the most important context of all – the fact that more than 1/3 of all medical procedures are unnecessary and wasteful, and the fact that conservative primary care physicians can save another 1/3 of the remaining 2/3 of that cost. Using conservative care physicians rather than GPs as the primary contact physicians can save nearly 50% of ALL medical costs in a gross context. The insurance/payment system isn’t the only thing that needs to change, it’s a bandaid.

  41. This guy somehow overcomplicated and oversimplified the whole subject at the same time, impressive. I don’t think i’m learning much here anymore, and must use my time more effectively elsewhere. Cya david.

  42. Here's an idea. Two years I was obese, type2 diabetic, and on my way to a heart attack. Now I'm 80 lbs lighter, and my A1c is 5.6….skinny and not diabetic and not taking pharmaceuticals. If it was hard I couldn't do it. I went on a Ketogenic diet..High fat, medium protean, very low carbohydrates. When I was hungry I ate, so I was never hungry. My idea is get healthy and you won't need a lot of money to pay for drugs and doctors. I'm now 68 and feeling really good.
    What if the whole country did that. What if doctors are the reason we are so sick in America.
    Just thinking out loud.

  43. The 800 lb gorilla in the room is just this: if you say that health care is an iron triangle which balances cost, quality and access and you say you can't change one with out affecting the others there by implying that increased access means lowered quality or higher prices, you have to be able to explain why European countries and Canada all seem to have higher quality, universal access AND lower costs. Why can they do what we are told cannot be done?

  44. How does M4A eliminate jobs? Billing still has to take place. Paving of streets still have to occur. Offices will still exist. It’s the lowering of ridiculously high costs of medications to boot. M4A b6 all means is much cheaper and jobs are not lost so quit with the dog whistles.

  45. How can you spend more money for his iron pyramid if you remove the insurance companies let the insurance people that loose their jobs work for Mc Donalds especially the CEO.This guy is full of shit. He doesn't want to change the corruption because he is part of it.

  46. This guy is full of sh*t. Other countries with universal single-payer systems spend approx half as much on healthcare as the U.S. with better outcomes (and we have 80 million people who are either uninsured or under insured). Yes, what makes the Swiss system work is heavy regulation and making the insurers non-profit (like Blue Cross Blue Shield used to be). M4All also removes the profit motive and regulates, and also operates even more efficiently than private insurers (Medicare's overhead is something like 2-3 cents on the dollar).

  47. This guy seems like he is vastly oversimplying despite clearly knowing his shit. The real world isn’t as simple as a magic triangle of trade offs. Countries that spend far less than we do don’t have lesser access or lesser quality. It’s not linear like that.

  48. ACA was an attempt to create a Swiss style system. People don't seem to happy with it and our leaders are unwilling to institute the regulation necessary to make the system function well. Any system that allows politicians to slowly chip away at regulations that lower costs or improve access will inevitably fail in America due to our political systems culture. I used to agree with this doctor that the Swiss system was a good compromise and would be something everyone could live with. I was wrong. Without access and cost controls built into the foundations of the system every time a politician is up for reelection and wants a campaign donation they're going to agree to increase patent length, vote friendly toward reducing insurance standards or increasing cost sharing. Which leads us to exactly where we are today needing to have the same exact fight all over again in 30 years. The only solution to this in the American context is to take that power from elected officials and prevent them from slowly ruining the system. As odd as it sounds the administrators in the executive branch need to run the show. This removes a good bit of political interference and allows for the rational adoption of best practices.

  49. Honestly, whether it's medicare4all or nonprofit private healthcare, republicans will fear monger it and call it socialism or communism.

  50. Medicare for all is basically just removing the unnecessary middle-man (insurance companies) and paying a flat fee (through taxation) removing any additional costs (co-pays, premiums, and deductibles) which effectively makes healthcare cheaper overall. Add the position of strength to negotiate better drug prices by having control on the expenditure of Medicare for all that too will reduce the overall costs of providing a national healthcare system compared to the current insurance based system. The additional benefit being EVERYONE GETS TREATMENT under Medicare for all, no ifs no buts, if you're ill you get treatment. No more worrying about the costs of getting treatment (and no more potential to bankrupt you if you do get treatment only to find out your insurance doesn't want to cover the costs) as it's all included in the cost paid in taxation.

  51. “Fraud is still somebody’s income”?! 😂 Theft is chill right? So you are telling me the amount of money your sugar daddy makes is criminal? Lol David lol I have never seen someone sellout to an ideology in my life like that. 💯 You got me David. Almost trusted you.

  52. Fraud is not somebody's income; it's theft. Fraud in healthcare kills. Plain and simple. Also, by recommending the Swiss system, Dr. Carroll omits the UK's NHS, which was rated the best healthcare system in a comparison of eleven developed nations by the Commonwealth Fund in 2017. The NHS was rated to have better access, administrative efficiency, equity, care process, and healthcare outcomes than the US (which was rated eleventh out of eleven overall). This flies in the face of "The Iron Triangle" caricature. Unfortunately, due recent events, it looks like the UK is going to get a taste of our system soon enough…
    https://www.commonwealthfund.org/publications/fund-reports/2017/jul/mirror-mirror-2017-international-comparison-reflects-flaws-and?redirect_source=/publications/fund-reports/2017/jul/mirror-mirror-international-comparisons-2017

  53. I live in Sweden 33% of my income is taxed, 66% of my income tax is municipal tax and about 9% of the municipal tax pays for my healthcare.

  54. What about the fact that if more people are insured, then they are using more medical services and getting more care, instead of foregoing treatment as they are now? That seems to have been left out of the equation.

  55. Australia's system is brilliant. We have medicare for all AND private for anyone who wants it. I lived in KY and had insurance, but they wouldn't pay for my mastectomy. They said I had the "wrong kind of cancer"! In the USA I'd be bankrupt or dead (and not paying tax). I had to fly back home. Here I'm back at work and paying tax. Catch up USA!

  56. Ha! "Fraud is still somebody's income" WTF!?! Al Capone contributed a lot to the local economy, maybe we sould have let him be.

  57. I'm a freelance artist, I haven't heard of The Iron Triangle, but always tell clients there's 3 factors, the work can be: quick, cheap, good. They can have any 2 of those at the expense of the third

  58. Things that are good about our system in switzerland:
    – It’s universal. Everybody is covered.
    – It is not coupled to jobs or anything else.

    Things that are bad about our system in switzerland:
    – It’s fucking expensive. Number 2 behind the US.
    – 25% of people need subsidies to pay for it. Which is billions going from the state to the private insurance companies.
    – There are about 50 private insurance companies. They advertise and try to gain customers, especially young and healthy ones. This makes the market very confusing and it is hard to find out which is the best option for you. It’s kinda like the phone/internet-provider market, except prices and stakes are much higher.
    – The adminstrative work that is required of the patients is quite high. You have to keep track of payments from and to doctors and insurance companies.
    – Meds are very expensive because there is no single payer who can negotiate good prices.

  59. the billionaires just dont want to pay tax toward medicare for all,they dont want to pay any tax for anything,so they buy the republicans and some democrats like nancy pelosi and chuck shumer,fox news,msnbc and lobbyist to spread lies and fake news and fear mongering to stop medicare for all

  60. Remove the profits from healthcare. It will become cheaper, and quality and accessibility won't suffer. The iron triangle is bullshit.

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