The Complete Moderate’s Guide to Healthcare


A fake Youtube chef cut his hand in the kitchen…
this is what happened to his wallet. KB is a 25… ish year old Youtuber, presenting
to the emergency room – which was a huge financial mistake. This video was brought to you by CuriosityStream. My original plan for this video was to take
that scenario through multiple different healthcare paths to show you all the options and costs. I very quickly realized that wasn’t going
to work. Even if I had done that, those numbers would
have been completely meaningless to you because of how healthcare works in our country. It’s not like ordering a Big Mac. The numbers I would’ve given you would only
apply to other 25-ish year old men living in [HARM TO ONGOING MATTER], it’s very unlikely
that it would be relevant to you. So there’s really no point in digging up
those numbers. Especially since the cost of a procedure not
only varies widely within the same city, but sometimes on the same block. A few stitches can cost anywhere from $200
to $3000. I picked stitches because it’s pretty universal,
there is no gender, or race, or even class, that is more prone to needing stitches. I’ve personally needed stitches at least
five times that I can remember. The obvious explanation for that wide range
is where on the body were you injured? Stitches on your shin are going to be easier
and cheaper than stitches on your eye. Except… no, some people pay less for eye
stitches. And these price ranges exist across the board
for all procedures, if you walk into a medical facility with a burst appendix, it’s going
to cost you anywhere from $1500 to $180,000. I somehow doubt that one appendectomy could
be 120 times better than another. Some cases are complicated and require extra
imaging or post-operative care, the point is, you don’t know that beforehand. When you get the bill, it could be anywhere
in this range. So rather than just shouting numbers at you
and laughing about how ridiculous things can cost, I want to explain why that range exists. Many of you likely know parts of the answer
already. The most obvious being that urgent care is
almost always cheaper than emergency care. Both with and without insurance. Urgent cares are a relatively new concept
in the US and provide a cheaper alternative for non-life-threatening emergencies. Like stitches. Let me be clear, when in doubt, go to the
emergency room, you will never be turned away, but if you walk into an urgent care with something
more serious, they might send you to the ER, possibly delaying lifesaving treatment. But odds are that if you only need four stitches,
it probably isn’t going to kill you any time soon. Emergency rooms cost so much more because
of the infrastructure and overhead required to keep a large hospital running. But also because of more nefarious reasons. 70% of hospitals in the United States are
privately operated but not run for profit, which is surprising to most Americans. Insurance companies, on the other hand, are
only run for profit. So in order to attract more customers, insurance
companies have to offer better deals. Which is somewhat difficult when a hospital
is non-for-profit. Usually, if you’re not making a profit,
it means your prices are already as low as they can be. Enter the hospital chargemaster. That’s not a chargemaster. Pretend. Every hospital in America has a list of prices
for every good and service they provide, which until this year, was kept hidden from the
public. Which is a huge problem in a capitalist system. You can’t really make an informed economic
decision if there is no price transparency or easy way to compare different costs. Not that you would ever shop around during
an emergency anyway. So the insurance companies went to the hospitals
– Side note, in some cases, the insurance companies own the hospital outright, and while
the hospital is a non-profit… they aren’t. – and said “hey, you’re currently charging
your customers $200 for this service, why don’t you increase your chargemaster price
to $250, but still only charge our customers $200, that way we can tell them we’re getting
them a discount.” This should sound familiar to anyone who has
ever shopped on Black Friday. Repeat that for every procedure or medication,
nationwide, and you have the first piece of the puzzle. When figuring out the cost of healthcare in
the US, you have to look at multiple variables, we’ll add to this list as we go, but we
can start with the base cost. The price of materials, labor, facilities,
and sometimes including those blue light chargemaster rollbacks. As we’ve seen, this base cost can range
from three to six digits depending on where you go. Which is the second variable – location. Not only are we talking about state or city,
but street. Add in provider type – are you going to
an emergency room, urgent care, or just your doctor – and you have even more variation. Since we’re only five minutes in, you probably
figured out that this list isn’t even close to complete. An unfortunate reality of our system is that
it also matters who you are. The Affordable Care Act made it illegal for
hospitals and insurance companies to charge you differently based on your previous medical
history, but they can still charge you differently for basically any other reason – including
gender and perhaps most obviously, your age. For example, stitches on an infant are objectively
more difficult and therefore more expensive. Bet that wasn’t the direction you expected
me to take the ageism argument. Procedures aside, age is one of the biggest
factors that contribute to the cost of health insurance. Alright non-Americans, get your laughs out
of the way now. [Laughs in Foreigner] Health insurance started
as a sort of membership program, known as Health Assurance, you paid a fixed amount
every month and any medical costs you incur were on them. Your health was assured. It didn’t take them very long to figure
out the formula for success. Obvious abuses aside, that simple just model
wasn’t sustainable. So over time, they have shifted more of the
cost of actually using medical services onto the consumer, called it Insurance, and made
the system so complicated that most Americans don’t even bother trying to understand it. Lucky for you… I’m not doing anything, I’ve got time. The health insurance industry didn’t really
take off until World War 2, along with rationing fuel and rubber, prices and wages were also
fixed by the government. So companies had to get creative to attract
talent. The most popular way was to offer benefits
on top of your salary, like paid vacation, housing, or health insurance. Today, 60% of Americans get their health insurance
through their employer. This is thanks, in part to ObamaCare, officially
known as the Affordable Care Act or ACA, which made it so that any company with at least
50 employees has to offer health insurance. Though “offer” is a bit of a loose term. Which is yet another factor – how much your
employer offers to contribute. Your insurance premium might be $500 a month,
but your employer might only pay half of it… or none of it. In order to discuss how insurance actually
works, let’s take a look at something a little more simple – car insurance. In most states, if you own a car, you are
also required to have car insurance. The more people who are paying into insurance,
the lower the cost for everyone – most people accept this reality when it comes to car insurance. But not health insurance, for some reason. The Affordable Care Act did a lot of good
things, like mostly getting rid of pre-existing conditions, allowing you to remain on your
parents’ insurance until you’re 26, and a bunch of other stuff we’ll get to later. But it also required everyone to have health
insurance, through the Individual Mandate. The hope being that the more people who have
insurance, the cheaper it will be for everyone, just like car insurance. But the mandate was just repealed so, never
mind, I guess. Everyone with insurance pays a premium, this
is like your membership fee and you pay this regardless of whether or not you actually
use it. If your premium is $100 a month and you never
get into an accident, that $1200 a year is simply gone. Because of this, a lot of people think of
insurance as a bit of a scam – If I didn’t use it, I should get it back or something. This is what I’m going to call Stage Zero
– you pay your premiums, you don’t use it, and nothing happens. Rinse and repeat, every year. There are two tiers of car insurance, the
lowest being Liability, which only pays out if you are at fault in an accident, and Comprehensive,
which pays for any damage to your vehicle, whether it be a collision or an act of god. But once you actually have an accident, you
enter Stage One, when you pay all costs out of pocket until you reach your deductible. This is the amount you have to pay before
your insurance will contribute. For many car insurance plans, the deductible
is also your maximum out of pocket – or MOOP. Who the hell is Moop? It’s the most you will pay to fix your car
in a given year. After which, you enter Stage Two, when your
insurance pays all remaining costs. Sometimes, there is a maximum annual or lifetime
benefit, after which you would be on the hook for any remaining costs, but that’s fairly
rare. So if you get into an accident that costs
$15,000, you would only pay up to your deductible, say five hundred dollars, and your insurance
company would cover the rest. Congratulations, having car insurance probably
saved you thousands of dollars. But when it comes to health insurance, most
people only focus on the cost, if they never go to the doctor they’re just throwing away
money every month. This is important, so pay attention. Not having insurance is only cheaper, if you
know that healthcare costs without insurance will be less than your annual premium and
your deductible put together. Remember, without insurance, you will be paying
regular chargemaster prices. Some hospitals might be willing to work with
you and give you the “discount” price if you’re uninsured, but you can never count
on that. For our car insurance example, that tipping
point would be $1700. If you know that your car repair costs are
going to be less than $1700, it’s cheaper to just go without insurance. But you literally can’t know that. You can’t predict if some if some random
tire is going to hit you. Just as you can’t predict if you’re going
to cut yourself or your appendix is going to burst. So let’s say you’re playing it safe, you
have health insurance, and something unpredictable happens… Just like car insurance, you started in Stage
Zero. You’ve been paying your premiums and have
been relatively healthy until now. You go to the hospital and you enter Stage
One, you are paying everything out of pocket up to your deductible, so far everything is
pretty simple. But Stage Two is where things become a bit
more complicated – this is when you and the insurance company split the costs of your
care, through two mechanisms. A copay is a flat fee, like $25 every time
you go to the doctor. That’s just to walk in the door, by the
way, if they do anything more than that, it costs extra. Usually through coinsurance, which is a percentage
rather than a flat fee, so for example, 20% of all outpatient procedures. Only copays and coinsurance count towards
your MOOP, premiums, prescriptions, and out of network costs, do not. Once you hit your maximum, you enter Stage
Three – when your insurance company covers all remaining costs. The Affordable Care Act prohibits any maximum
annual benefit or lifetime limits for health insurance, though they can still exist for
dental and other insurance types. So Stage Three has no maximum dollar amount,
but your MOOP is annual limit that resets each year. This is the next variable we’re going to
add to our list – When the healthcare cost occurs. If your appendix bursts with only one month
left to go in the year and you hit your maximum out of pocket, if you still need continuing
care the next month – which is also technically the next year – you will have to pay your
maximum out of pocket again. Effectively doubling the cost of this single
event even with insurance. There are many different types of health insurance
programs, all of which cost different amounts based on what kind of care you want. Or more likely, what your employer chose for
you. The cheapest type is an HMO or Health Maintenance
Organization which operates through smaller networks of providers. Another very important term and concept. Doctors and hospitals sign agreements with
insurance companies to be part of their network and see their patients, sometimes at a reduced
rate, as I mentioned earlier. If you’re on that insurance, you can only
see those doctors and hospitals. If the doctor or the insurance company decide
they don’t want to work together anymore – you don’t get a say. If you like your doctor, or health plan, you
can keep your doctor. He couldn’t legally mandate that your doctor
and insurance company continue to work together forever – this is America. So now your doctor is out-of-network. If you see an out-of-network doctor, you will
very likely be on the hook for the entire, non-discounted bill. And you might not know it until afterwards. It’s not uncommon to go to an in-network
hospital and be seen by a prohibitively expensive out-of-network specialist at that hospital. HMOs typically have lower premiums up front,
but higher out of pocket expenses later. Everything is routed through your Primary
Care Provider, they make decisions about your health and you can’t see a specialist without
a referral or pre-authorization from your insurance company. That doctor acts as a gatekeeper for your
healthcare… which would make the insurance company the keymaster? The other end of the spectrum is a PPO or
Preferred Provider Organization, where you don’t have a primary care provider deciding
on what specialists you see or what care you receive. The premiums are higher but the out of pocket
expenses are lower. They typically have a larger network than
HMOs and out of network care is significantly cheaper, you don’t need a referral or pre-authorization. So it costs more to have more control and
more choice in your healthcare. That’s how capitalism works right? More choices and competition leads to higher-
wait… And then you have all sorts of programs in
between. Like the Exclusive Provider or EPO, which
is similar to a PPO, but out of network costs more and you might need pre-authorization
to see a specialist. Then there’s Point of Service, which is
like an HMO but out of network costs less and nobody abbreviates it. It’s a mess and even the definitions I just
gave you vary from company to company and state to state. But in general, those are your options, yet
another variable to add to the list. But wouldn’t it be great if we could just
cut out the middleman and pay for our own health care? Yeah, or you could- Shut up this is America. Some people have the option of getting a High
Deductible Health Plan or HDHP, which have extremely low premiums and extremely high
out of pocket costs. But it unlocks the ability to create a Health
Savings Account. An HSA is very similar to an IRA retirement
account, any money you pay into it is tax free and as long as you only use it to pay
for your insane healthcare costs, it doesn’t get taxed on the back end either. But wait, it gets better. Just like an IRA, you can invest your HSA
money, growing it potentially infinitely… which you also don’t have to pay taxes on. This is why they call them triple tax shelters. If you’re like me, you’re already googling
how you can open one of these up, and I’ve got some bad news for you. You can only open an HSA if you have an HDHP. If you’re on any other form of health insurance,
or even no insurance, this option is not available to you. And unless you’re perfectly healthy, that’s
probably a good thing. The astute amongst you will have noticed that
I haven’t given you any numbers for these programs… and there’s a reason for that. Not all HMOs and PPOs are created equal. Another good thing the Affordable Care Act
did was to establish a standardized tier system for health insurance, so people looking on
the marketplace can actually price compare and shop around. The absolute lowest level is called Catastrophic
insurance, these are typically your HDHPs, gamblers who are saving up their money and
hoping they never get sick or end up in a car accident. That’s about the only thing these plans
cover – emergency services. In America, all health insurance plans, regardless
of type or tier, cover emergency services in- or out-of-network. Though once you’re stable you better leave
that out-of-network hospital or the bill will give you a heart attack. Which just repeats the cycle. Catastrophic plans are like only having liability
insurance on your car, it really only helps you in the worst of situations, otherwise
you’re on your own. You also have to be under 30 to get it, which
means it doesn’t apply to me anymore so- I mean, it does apply to me for the next five
years. The four main tiers of the Affordable Care
Act are bronze, silver, gold, and platinum. The better the metal, the more you pay in
monthly premiums, but also, the lower your out of pocket costs when you actually receive
care. The ACA defines these tiers by the average
coinsurance for the plan, they call this the actuarial value. For Bronze, the actuarial value is 60%, they
pay an average of 60%, and you pay 40% in coinsurance. In Platinum, you pay 10% and they pay 90%. Again, this is the average, for some services
it might be 92% while others might be 85%. At the end of the year you might find that
you actually paid 11%. The actuarial value is the only definition
for the tiers – premiums, deductibles, and MOOPs can be all over the place. There’s really no way for me to compare
a Platinum HMO to a Silver PPO or a Bronze POS. Making this another determining factor in
your overall healthcare costs. But for the sake of an example, let’s just
pick one: gold. The average monthly premium for a gold-tier
plan is $597 a month for an individual and $1252 for a family. The beauty of family plans is that it usually
costs the same whether its two people or seven. If you’re getting a gold plan through your
employer, they might be paying for some of it. If you got it through the health insurance
marketplace, healthcare.gov, you might be getting subsidies to help. But for our purposes we’re just going to
stick to the base cost. So, let’s say you need those $3000 stitches. An individual gold-plan deductible can range
from $1000 to $5000, but the average is $1320. Remember, you pay that much before insurance
even kicks in. The remaining cost is shared between you and
the insurance company at a 20-80 split, only costing you an additional $336. The average individual gold plan MOOP is $5878,
so we’re not even coming close to stage three. In the end, those $3000 stitches cost only
$1656, just over half, wow, it’s a good thing you had insurance… You forgot ab-
Son of- yeah, as most people do, I forgot about the premiums. On top of the stitches, you paid $7164 in
premiums, bringing your total health care costs for the year to $8820. Here’s the same scenario for the average
gold family plan. As I’ve said, it’s impossible to know
whether an uninsured person with the same $3000 injury would fair better financially… But it is possible. And while the person writing the $1600 check
while paying monthly premiums is going to feel a lot more financially secure than the
person cutting $3000… The economic realities of healthcare costs
in America don’t care about your feelings. Now, I picked gold as an example because it
has an actuarial value of 80%. Which is the exact same as Medicare. Medicare is a socialized health insurance
program that covers 59.9 million Americans, most of which are over the age of 65. It is the largest single provider of health
insurance in America. I briefly covered Medicare and how it’s
funded in my video on welfare, along with another program for poor people called Medicaid. Medicaid is run at the state-level. So while it covers 74 million people, they’re
spread across 54 different state and territory programs that all set their own requirements
and pay outs. A single person in Alabama must make less
than $771 a month to qualify for Medicaid. The average panhandler makes $25 a day begging
for money on the corner – if they’re out there every day this month… Maybe take Halloween off, is all I’m trying
to say. Medicaid benefits depend on your income level,
at the lowest you’re paying single digit copays and at the highest, 20% coinsurance. Just like Medicare. But while Medicaid is a complicated welfare
program, Medicare is not. It’s government-subsidized health insurance. Every American who works pays into it with
a 1.45% FICA tax, which is also matched by your employer. If you contribute for ten years, you get full
Medicare when you turn 65. Medicare is not free, it’s also not simple
– but since it currently covers 20% of all Americans and presumably will cover all of
us once we’re old enough, it’s worth looking into. I need to start by saying that this is just
an overview. Most of my audience is several decades away
from Medicare, so if you’re currently in the process of enrolling, please speak to
a professional, this is just an introduction. There are entire channels dedicated to explaining
Medicare – we’re just going to scratch the surface. Medicare has four parts. Part A is for inpatient services like overnight
stays at a hospital. For the vast majority of people, there are
no premiums for Part A. But there is a $1364 deductible and a complicated copay and coinsurance
table. Medicare Part B is for outpatient services
like regular doctor visits. This does have a monthly premium for most
people, but before I tell you what it is, remember that you’re getting an actuarial
value of 80%. $135.50 a month – regardless of who you
are. But we’ve learned that low premiums usually
equate to a high deductible so- $185 deductible. So because stitches are usually an outpatient
procedure, we can figure out that those $3000 stitches would cost you $748 out of pocket. And $2374 a year in total expenses. There are no family plans in Medicare, it’s
just for the individual retiree, and these are by far the cheapest stitches we’ve come
across so far. But there is a catch. Medicare Part A and Part B, collectively referred
to as Original Medicare, have no maximum out of pocket limit. You pay the same 20% coinsurance to infinity
and beyond. Which is why we need to talk about Medicare
Supplement Plans, also known as Medigap plans. These add a MOOP, as well as reducing your
coinsurance. This is an addon run by a private insurance
company that doesn’t get to decide what or how much they cover, that’s dictated
by Medicare. They do get to decide what to charge you though. Alternatively, you can scrap Original Medicare
altogether and opt for Part C – better known as Medicare Advantage. This is a private insurance plan that takes
the place of Parts A and B (and sometimes D) and acts as its own supplement, so you
get a MOOP. You pay your premiums to them, rather than
Medicare. Now the insurance company gets to make decisions
about your healthcare, instead of the government. And it is required to give you that same 80%
actuarial value… in theory. In practice, the HHS Inspector General recently
found that 56% of people on Medicare Advantage were denied necessary treatment simply for
monetary gain. I know, right? I was just as shocked as you. About 36% of people eligible for Medicare
opt for Medicare Advantage, so when you hear someone complaining about Medicare… There’s a decent chance they’re not actually
on Medicare. And I’ll give you one guess as to which
Part ends up with the most waste, fraud, and abuse… It’s actually Part D, which is your optional
prescription drug coverage – but before you get mad at me for the bait and switch,
both C and D are run by private insurance companies. I’m not kidding, Part C and D waste, fraud,
and abuse is rampant, you can find the powerpoint presentations from HHS online. The problem is that when the news tells you
about Medicare waste, they usually leave out which Parts are causing that. And when they talk about healthcare statistics,
they neglect to mention that a third of the people are actually on private insurance. The 59.9 million number I cited earlier is
Original Medicare and Medicare Advantage put together. There are 44 million people on just Original
Medicare. And 90% of them don’t use Medicare exclusively,
they get a Medigap supplement plan or a Part D Prescription plan, or both. Prescriptions aren’t usually covered by
health insurance. Even in countries with universal socialized
medicine, dental, vision, and prescriptions are usually separate. And prescriptions drugs are even more of a
mess than healthcare. Each Part D plan has a list of prescriptions
they cover called a Formulary, you’ll need to look over that list when choosing your
plan. I hope you accurately predicted what medicines
you’ll need in the future. Americans pay the absolute highest prices
in the world for medications, sometimes by an order of magnitude, and the main reason
is somewhat counterintuitive. The UK has a single payer system known as
the National Health Service or NHS, every British citizen is covered for almost no out
of pocket cost. A total of 66 million people. The government negotiates prices with drug
companies, knowing that they will be the only supplier of that medication to 66 million
people. So they get a pretty good deal. There is no equivalent in the US, the government
doesn’t negotiate or even really regulate prices – the best we have is Medicare with
44 million people. And there’s a reason they pay the least. Counter to the common capitalist perception
that competition and choice drive down prices – at least when it comes to healthcare – market
share seems to have much more influence. The more people you are negotiating on behalf
of, the lower your prices. But also, it costs a lot of money to develop
treatments and medications, so most companies want to make the largest return on investment
as they can. But when you’re selling to the UK and Germany
for such low prices, where are you going to make your money? The country that isn’t negotiating on behalf
of 320 million people and has little to no regulation regarding price ceilings. Why do they charge so much? Because they can. The common argument against adopting a system
like the UK is that they are incredibly overtaxed. So let’s get our calculators back out and
check. The median household income in the United
States is $59,039, assuming just the standard deductions for a single person, you would
be paying $10,804 in federal taxes – both income and FICA. I have a video all about income taxes if you
want to know the actual math behind that. If you took that same income and went to the
UK, after converting to pounds and then back again, you are paying $14,451 in national
taxes. This includes your income tax and the National
Insurance tax, which is like our Medicare tax but, significantly larger. Side by side, if you make the median household
income in the US, you are paying 18.3% in federal taxes, if you took that to the UK,
you’d be paying 24.5%… but remember, healthcare is included. If you want healthcare in the US, the average
annual employer-based premium across all types and levels for an individual is $6896 a year. So in reality, you’re paying 30% of your
income in taxes and health insurance – and that’s not even considering what happens
if you actually get sick. In the interest of being thorough, if you
double the median income to $118,078 and were married with two kids – you would be paying
significantly more taxes in the UK. However, your healthcare expenses don’t
really change, whereas the average employer-based health insurance premium for a family is over
triple that of an individual. So a US family is still paying more in taxes
and healthcare – even if they never go to the doctor. The UK does have a Value-Added Tax, or VAT,
of 20%. But their cost of living is about 7% lower,
so once you consider sales tax in the US, prices are pretty comparable. A Samsung Galaxy S10 costs about $15 more
in London than New York. And a Big Mac is a dollar fifty cheaper. The quality of these products are pretty much
the same wherever you go, but for some reason, we insist that US healthcare is the exception. That has to be the last variable on our list,
American stitches are just inherently better than UK stitches. No, most people already know this, but the
UK, Canada, Australia, and most other industrialized countries beat us in just about every healthcare
metric. Life expectancy, infant mortality, maternal
mortality, the list goes on. But generally, these numbers are close enough
that you can say that the US is basically on par with everyone else. But per capita, we’re paying double what
they are. Objectively, the UK does have longer wait
times, from a few more minutes in the ER to a week or two for a specialist. But I want to challenge your assumptions here. If waiting a little longer drastically reduces
cost, but doesn’t negatively impact healthcare outcomes… How important is it to be seen right now? Can you zoom in and say the US is better in
a specific field like heart transplants or post-op complications? Sure, but overall, we’re not getting what
we’re paying for. Which is why we’ve been arguing about how
to change this system since forever. But we might actually do it this time. I’m obviously not going to talk about all
of the proposals, because you’ll never hear from most of these people ever again. So let’s just focus on two. Mayor Pete is proposing a Medicare opt-in
plan or “Medicare for all who want it.” This is just a reskin of the classic “Public
Option.” This would open up Medicare to anyone, if
you’re uninsured, you’re automatically on it, if you get health insurance through
your employer, you can switch, but otherwise nothing changes. Unless your employer wants to switch to Medicare,
in which case you don’t have a choice. It would also make a few smaller changes like
adding a Medicare MOOP and capping out-of-network costs. Most people wouldn’t see any changes to
their healthcare. Which isn’t very exciting, so let’s talk
about the plan you all want me to – the Medicare for All proposal from Kristen Gillibrand. She’s not even running anymore. You won’t let me just have- Fine, let’s
talk about Bernie Sanders. Bernie’s Medicare for All plan would basically
turn our healthcare system into the UK’s, with a single payer government health service. But with dental, vision, and prescriptions
included. Like the UK, there would be no premiums and
little to no out of pocket expenses. It also abolishes private insurance. No more employer-based health plans, no healthcare
marketplace, no deductibles, no premiums, no channels completely dedicated to demystifying
Medicare. You and your doctor will make decisions about
your healthcare, not a private corporation. Instead, the government would be the third-party
payer. How they would pay for this is always a point
of contention and oftentimes the question is intentionally worded poorly. How much are your taxes going to go up? And you said… How much are your costs going to go down? No, different question, how much will your
taxes go up? No, it’s how much are your costs, because
it’s- This sounds like a dodge because she’s trying
to reframe the question. Taxes will go up, primarily for the wealthy,
but likely the middle class as well. But remember, even if your taxes went up by
50%, the fact that this expense no longer exists means you are still better off – and
you won’t pay much more, if at all, when you need medical care. This would also reduce the overall bloat in
our system that contributes to the high cost. Your HR person has to pick a health plan,
hospitals and doctors need to hire special billing coders, the insurance company needs
claims specialists, and youtubers need to make videos explaining it all. I’m positive we can do better than this. But if you insist on keeping your healthcare
expenses unnecessarily high, even under the proposed Medicare for All, might I suggest
getting into vitamins and supplements? An industry you can learn all about by going
to curiositystream.com/knowingbetter. CuriosityStream is a subscription streaming
service that offers over 2400 documentaries and nonfiction titles from some of the world’s
best filmmakers that you can access across multiple platforms. Learn all about vitamins and the industry
that sprung up around them in this documentary hosted by fellow youtuber, Veritasium. Even though I know most of us don’t really
need to take vitamins, I can’t seem to help myself. You can get access to their entire library
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and use the promo code knowingbetter, you can have the advantage of getting your first
month completely free. As well as getting access to Nebula, the new
streaming service put together by youtube creators to have a space to create videos
without worrying about algorithms and demonetization. My channel, as well as many of your other
favorites, can be found there, including several original series. By joining CuriosityStream and Nebula, you’ll
also be supporting the channel. Full disclosure, I have no horse in this race. I am a service-connected, disabled combat
veteran, I get my healthcare through the Veteran’s Affairs hospital – which isn’t a health
insurance program. It’s a self-contained system and a bottomless
well of asterisks. So I’m not complaining about the system
and talking about proposals for change for my personal benefit. I also had no reason to give myself all that
math homework. It took me a month of daily research to figure
all of this out and present it to you and that alone should tell you this is overly
complicated. Luckily, I don’t do anything else with my
time. So now, as you’re watching debates about
taxes and reading news articles about rising premiums, you’ll actually understand what
they’re talking about, because now, you know better. If you hadn’t noticed, I made some improvements
to the set, so if you’d like to add your name to the chargemaster, head on over to
patreon.com/knowingbetter, or for a one-time donation, paypal.me/knowingbetter. Don’t forget to copay that subscribe button,
check out the merch at knowingbetter.tv, follow me on Twitter and Facebook, and join us on
the subreddit.

100 thoughts on “The Complete Moderate’s Guide to Healthcare

  1. In the interest of being a Moderate's Guide and covering bOtH SiDeS – the Republicans want to keep things the way they are… maybe even privatize them more.

  2. This is the kind of stuff that makes me glad I don't live in the US. Between this and your tax system, I wouldn't have enough time to enjoy all my freedom.

  3. Thanks for the vid KB.

    I’m a free market capitalist all the way( and I’m very skeptical about the governement running things!). However Health Care is way more complicated than running say…a reataurant.

    So I’m open to changing my mind.

    Cheers and God Bless.

  4. Why did you choose $59k for both countries USA and UK?

    Average income is 40 percent higher in the USA, and goes to the point that socialism reduces productivity. If you factor 59k equivalent UK versus 84k in the USA, your numbers get destroyed, and any sane person would prefer the USA version. More money in your pocket, more things you can afford, and lower wait times for care. Hello???

    Also consider, the socialist countries are using the power of an authoritarian government to tell a worker he is legally not allowed to charge the price that the free market would otherwise permit. This is like a concept of partial slave labor. That's immoral. If you want to demonstrate that slave labor can yield lower costs, I'd say yes that's why slavery existed, but it's immoral.
    If the USA implemented price caps on medicines, EVeRy socialist country would suffer an immediate slowdown of research and technology. Basically the socialist countries are immorally shifting the cost burden of very expensive research onto Americans.

  5. So two things I feel like were missed in this video that should have been addressed as potential negatives to medicare for all.

    1) Why do people use private insurance as a proxy for Medicare? I can't speak for everyone but for my parents it was a requirement. Why? Because most doctors in our area will NOT take Medicare or Medicaid patients because those systems have too much bureaucracy even compared to private insurance and pay too little. Paying too little is a big issue because a lot of doctors are trying to pay off hundreds of thousands of dollars in student debt. What are we going to do so being a doctor is more affordable?

    2) I thought the taxes versus cost debate was glossed over as a none issue and I really don't think it is. You mentioned that 60% of people get their insurance through their employer. Now let's say we go to a medicare for all plan. Do you really think that cost savings is going to passed over to the employees? That's an honestly laughable statement. Most companies are simply going to pocket that savings they aren't going to turn around and give everyone $600-$2000 dollar raises. So there is a case to be made that the average person is going to see costs go up through taxes while the company they work for will see a huge boon in their profits. No one has convinced me that the average person will see costs go down through a major bump in salary.

  6. My brother broke his arm really badly, he severed a nerve and his bone stuck out into the sand where he broke it. We needed to get a flying doctor and an ambulance plus all of the hospital services. You know how much we paid? Nothing. We live in Australia where we have a public health system that pays pretty much all of your medical fees. Seeing the American system and how complicated/expensive it is makes me sad.

  7. Hahahahahahaha…
    Im brasilian, our heathcare is even worse, i dont even know why im laughing at, BUT AT LEAST ITS FREE, hahahahahahaha…

  8. Got fucked up and ended up on socsec when I was a little over 30. Been on part A and part B ever since. I spent years scared to even try and use, I was convinced that healthcare would kill me, I literally did my own sootchers a couple times.

    Once I finally needed my medicare I realized it was simple and good. It’s actually very easy, I just go to whatever doctor I need, pay far less than most people ever would, and get taken care of.

  9. Jokes on you Americans scrubs. Up north we don’t get bankrupt for using the emergency room. All it cost was one full night in the emergency room.

  10. I really appreciate you doing the math. I'm guessing you did it all yourself. Why do the politicians NEVER GIVE THESE DETAILS?
    ?

  11. So this might turn into a long long post, we will see in the end i guess. So im at around 6:50 in and i think it would be great time to explain some economics, im not saying what you are saying is wrong at all but i will explain why adding those cost to the companies might not be in your own best interest.

    Companies are privately owned and driven by individual citizens, most of them have a profit incentive as well, they decide for themselves how to handle their economy. Now you place the healthcare cost on them, what will they do with this cost? They need to get the money from somewhere in order to pay for it, they can get this money from 3 different places. Either they pay their employees less which wont work as then all the employees decides to quit, they can increase the price of their product and make the consumers pay more for their product which in a competative economic landscape might be a very very bad decision for the employees and the owner. Or which is the more likely route to go, they go to the state and say "look you have placed this financial burden on us, and with it we cant survive" so the old state pays them in one manner or another, tax benefits, deductibles, or take over the cost. Which might sound like a great idea, but then all you need to know is that all the money the state can use comes from taxes, so we still end up paying for it, one way or another whatever they do, the cost is still on us.

    No the more people paying into car insurance doesnt make it cheaper, because the more people that buy into it places the financial cost on the insurance company in case of an accident which is as you might have guessed doesnt drive accidents down. What they have done is spread the risk around a lot more so they have a more stable economy, which makes them more able to deduct just how much their insurance have to cost in order that they still make money.

    Premiums are there to drive the cost of everyone elses insurance down in order to make that insurance company look like a better financial choice, do you really need to have this explained?

    You want a better system thats cheaper and easier for everyone? Now it wouldnt necesserily be better for everyone it sort of depends. Get rid of all programs and insurance all together throw all that shit into a bag, take that bag and put it into a rocket, then target that rocket at the nearest black hole and wave it bye bye. Secondly cut away a lot of the regulations on the hospitals so its easier to start one and operate one (this will increase the number of hospitals by the way). Then once you turn 21 you are free to sign whatever deal you so want with whatever hospital you so want, who might be in a network with other hospitals for competance and other things so you will have some but not perfect healthcare while in another town or state. Problem solved!

    Now you might ask me why, which is a very fair question and its rather easy to explain, let the hospitals be for profit you can not get away from that here. That way they need to compete with other hospitals for customers (their source of income) and one of the major deciding points for any customer is always the cost.

    This leaves medical emergency out a little, but force all the hospitals (yes by law) to pay a small portion to cover all of the costs for any emergency any signed customer has with any hospital. This money would obviously also come out of your own pocket through your signed deal. Make a law what is an emergency or not so hospitals cant cheat in that area.

    But there is nothing else that works better i think, i live in Sweden we have "free healthcare" which we pay for through our taxes, the hospital queues are going up and we have thousands of people every single year who die with perfectly treatable medical problems due to the long waiting lines, so if they spot your problem too late you're fucked. You might think we have cheaper health care here in sweden, we dont the cost is just hidden in our taxes which is why we have insanely high taxes (one of the reasons) effective tax rate is around 60-70% At the very lowest 62.5%.

  12. Not all insurance companies are for profit. BCBS for example, a lot of them are nonprofit.
    One thing I don't understand, combined they insure 1/3 of all Americans. But they don't get this group discount. Does government prevent them from working together to have greater buying power?
    I remember during Affordable Healthcare discussions, being able to shop across state lines was being pushed by Republicans but never included in this bill.
    If the goal is to create large pools of people to increase buying power, something like this seems like a no brainier. That is, unless people in the government don't want that to possibly actually be successful so don't want to make it legal? Is this what limits the buying power to each individual BCBS company, and not bargain as a whole with +100 million policy holders?

  13. I say Medicare for all. I mean the rest of the developed world solved this problem decades ago (I know the NHS was founded in 1947, but I don't know about other universal healthcare system). I don't see why we can't do the same.

  14. I actually couldn't figure out how to express just how good I think your videos are so… good job? Yeah, good job! 🙂 Anyways, I'm not associated with the military outside of a grandfather, but a video covering veterans' affairs would, I think, be rather interesting.

  15. You compared US healthcare system to auto insurance, but you didn’t say anything about inter-state commerce … I can buy car insurance from any US auto insurance company, however, I can’t say the same for healthcare. This restricts competition which traditionally lower costs… like auto insurance. Or did you talk about this and I missed it…. or you did this video with a single payer bias? I really enjoy your videos, cause you keep to the facts… this is the first video I have watched of yours where I sensed a clear bias and for me… it’s a bummer… but still interesting videos where I can learn things I didn’t know I wanted to learn… and for that… THANK YOU!

  16. "He couldn't legally mandate your doctor and insurance company work together forever" but he can legally mandate you pay for it, forever?!?! A nice dig on the "free market" but not much about how the government regulation through the years has kinda screwed that free market up hu?

  17. My local ER gave me a 20% discount for not having insurance, cost me ~$4000 for some morphine and a ct scan. I haven't run the numbers but I've been convinced since it happened that I still saved money overall since that has been my only medical expense in the last 3 years in which I had no insurance.

  18. 25:07 Counter to the common socialist perception, the state that "wants" you to have affordable health insurance because they "care" about you is the same state that puts people in prison for smoking a plant or collecting rain water. True capitalism and true choice means you can find other means of helping your ill self with no fear of getting the same punishment murderers and rapists get. You know. Prison.

  19. You compared US healthcare system to auto insurance, but you didn’t say anything about inter-state commerce … I can buy car insurance from any US auto insurance company, however, I can’t say the same for healthcare. This restricts competition which traditionally lower costs… like auto insurance. Or did you talk about this and I missed it…. or you did this video with a single payer bias? I really enjoy your videos, cause you keep to the facts… this is the first video I have watched of yours where I sensed a clear bias and for me… it’s a bummer… but still interesting videos where I can learn things I didn’t know I wanted to learn… and for that… THANK YOU!

  20. What if we broke up government created monopolies and corporate welfare to allow for more competition to drive down prices, and possibly had a UBI + 10% VAT like Yang proposes?

  21. Great, now ur going to see a certain political group bitch n moan amit how bad a socialized health care is bad, but thr fact that private companies are great, even though the guy shows proof they just want money

  22. Non-profit hospitals still have to make money for upgrades, and are subject to both structural problems that increase costs of healthcare, and subject to occasional vanity project spending.

    My point is, non-profit hospitals are still under the thumb of drug companies, device manufacturers, and generally to prices that aren't controlled by competition, nor regulation.

  23. you need to do a video on the benefits of a whole plant based diet on health/health care costs, living expenses, and the environment. your mind will be blown.

  24. And that's how you know everyone has dollar signs for eyes when you get even the smallest injury !

    I'm thinking to go learn CPR and light medical stuff myself. Fuck it, I'll put my own godamn stiches. Oh wait, I live in EU. Still … if zombie apocalypse happens soon …

  25. The lack of argument for this current system is telling. Universal care is so obvious that the other side doesn't even have good reasoning for the way our system works. Great video. I am obviously a big Bernie fan so I am digging any references. Any plan on doing a guide to the democratic primary? Probably next year so the field is whittled down. Keep up the great work. I am open to any topic for future videos. Do what catches your interest.

  26. Oh hey what would the cost structure be if we directly paid for insurance ourselves and hospital organizations ran their own direct-pay subscription-style services akin to the emerging direct primary care market that sees wildly improving health outcomes, pushes preventative medicine harder than ever before, and eliminates all of the bloat of working through an employer and an insur-

    Oh nevermind this is an advocacy video for single-payer that simultaneously acknowledges how the U.S.'s private system is funding the world's healthcare in one moment but ignores the inevitability that if it switched to single-payer, the motive to innovate would be diminished and the 50 to 100-year A-B scenario outcome is that the world would be worse off…

  27. 28:40 It's all about entitlement. I'm so fucking important, I'm the center of the fucking Universe, I'm a star and you will see me NOW mister !

  28. Glad I live in Canada, find a weird lump and I don't have to decide between rent and going to a specialist, Yeah it's not perfect but the fact I don't live in Toronto, Vancouver or Montreal means I have a minimal to no wait time.

  29. This makes me honestly wish that people who don’t support universal healthcare would just all up and leave America so we can have more affordable healthcare.

  30. I honestly think outlawing for profit insurance would be interesting because it forces the greed factor way down but I also don't think the government would do well with Medicare for all because the government sucks at most things

  31. An important point you (probably?) forgot to look into or address:

    Medicare for all (which I do ultimately want) should save lots of money . . . BUT!

    If you currently get healthcare through work, your employer often (usually? Seems usual around here in MA) pays a big chunk of your monthly premium. Unless M4A is written to force your employer to give you the money it had been spending on your premium (and that assumes such a thing is legally permissible), almost every employer will keep those savings for themselves.

    Sure, you start getting more pay because your premium disappears and your employer isn't deducting your (say) half of a monthly $1000 premium from your check. However, they aren't going to give you the $500 that technically they were paying straight from the company.

    So the already tricky math that took you a month to get together to prove M4A will cost most people less in taxes than they otherwise pay in premiums and other med costs, I'd wager, at least wouldn't look as good as you presented. I think overall that employees would still spend less, but perhaps not significantly less without taking home the employer's former premium portion.

    Still, even if I'm right, BRAVO for tackling this issue. It's better than anyone else I've seen trying to tackle it so far.

  32. I'd rather have a longer wait time than being priced out of any care at all. What good is "faster" healthcare if you can't even fucking afford it? The US needs to get its shit together. Anyone still rooting for the conservative on this issue is either wealthy or fucking braindead.

  33. It is cheaper to take the flight to Bulgaria, stay in a hotel and get the operation for a fraction of the cost.

  34. I fucking love my country and have many reasons to be proud to be a American but holy FUCK health care is not one of them.

  35. The tax comparison between America and the U.K. is the part that most voters in the USA either don't get or are operating on misinformation and politicians do a lousy job of simplifying and explaining that, even presidential candidates like Warren and Sanders. Americans just don't understand the idea that yes they are paying more in taxes, but actually getting something back for their money. It's ridiculous.

  36. Doesn't help the debate when national pride is brought to the table. I find that many Europeans bring up America's health care system whenever they need an easy target for why they think they're better than us which obviously causes some tension.

  37. Americans:

    Universal healthcare? No thanks, I don't want to pay for other people's healthcare. I like private insurance, where I pay for other people's inefficiently-delivered price-gouged healthcare AND the salaries of bloodsucking middlemen whose entire purpose is telling me NO when I need medicine.

  38. very good video, I wonder how the math changes when the US isn't where the money is made, like how much do the tax percentages go up

  39. Americans are funny. They see an issue and come up with convoluted and confused "solutions" that attempt to appease all sides and end up disappointing all those sides. Instead of, you know, looking up how other countries have already solved those issues and just copying that with maybe some minor changes. You people really need to get out of your country more, there's a whole world out there.

  40. Forgetting the most important property of single payer. Since the hospital can only have one client at any time, it's that one client that sets all the prices.

    The hospital can either take it … or go out of business.

    Also private health insurance in my country costs 11€/month. That is the extra insurance for hospitalisation not paid automatically by the goverment.

  41. OMG. I'm from Germany. We pay 8,5% of our pay check up to a maximum of like 800€/month. And that covers all. YOu've got the flu, need an ambulance or have cancer – no extra cost anywhere.

  42. the more I watch your videos, the more I feel like the USA just have to make everything sooo much more complicated than it has to be.:D

  43. I am from the USA but have been in Belgium for ten years. I didn’t realize how stressful the US system was until I didn’t have to deal with it anymore. Love Chubby Emu’s channel too! Also I think I recognize your Brit friend’s voice that makes an appearance too but I can’t quite place it. 😁 This is good quality YouTube.

  44. I'm a disabled veteran, I don't pay anything for my healthcare. Sorry that the rest of you are getting fleeced so badly.

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