Fixing US Healthcare System | Yaron Brook Show

We are going to talk about healthcare today. We're gonna do to healthcare what we try to do to find nancial regulation, to China policy, to what was it immigration and now healthcare. I mean, at the end of the day, what we will have here I think by the time we finished the series is a blueprint, a blueprint for how to move the US economy, how to move US politics, how do you move the US government towards having a rational policy overall? So this is a roadmap for all

of that. Maybe maybe we can get transcripts of this and get it wrong in writing and put it on a book called, you know, rational policy for irrational World, Rational Policy for the world in which we live, So it's going to be a plan, a plan. So I will be kind of using the same template us with immigration and with with China policy. I think to some extent I keep making slight changes to it, but generally, generally this is the template. And this one is sponsored by a few of you, so a few of you

sent money in. Let me also say this, this is a big one health can in particular, it's like finance. As I said, in Finance, it can't be done in one show, and I didn't try to do every aspect of finance and everything in finance. You can't do health can one show. There's so many dimensions to this. We'll cover a lot, but we could go in depth into any one of these. And I am not familiar with all the laws and all the regulations and all the complexities associated here. So we're gonna take a kind of

big picture. We're gonna go into more detail on things that I know and understand and I think are important. But we need a few shows to do this, and we will be doing more shows on this, so stay tuned. There will be more healthcare shows. This has shown number one. Thank you for those of you who have sponsored this show. Let me just put it out there that if anybody out there wants to sponsor a show on I can

think of Education would be really really good. Open somebody suggested labor laws, label laws would be good, although I probably have to bring in somebody. No, I mean labor laws. I could do label laws and think think about anything else, any other realms that you might want to that you might want to meet a cover in this way on the show. I mean, we've done one aspect of phone policy China. We could do other aspects of phone policy.

We could do the Defense Department. We just do a show on the Defense Department and what that would look like. But yeah, I mean so basically it saw a thousand dollars a show. But we can aggregate. I think this healthcare show, we had a couple of people do five hundred each. And you know, hopefully if you guys want to do education or one of these others, we can put together, you know, whether it's two hundred and fifty each or you know, five hundred, five hundred each, or

we can put something together to make that happen. So just let me know if there is interest and we'll organize it. And of course, if you have ideas for other topics, you know, let me know. Environmental regulation would be a pretty good one. I don't think I have anything to add to what you know Alex publicizes on a regular basis on energy policy. Environmental law would be would be really good. It would be the government's perspective environment And then we could do more on finance, and

we will do more in healthcare. So what to do with federal lands, that's easy. That w take ten minutes, five three sentences, two words, two words. Here, here you go. Here's what to do with federal lands. Sell them, sell them, auction them off to the highest bid of That's it. That's what I have to say about federal alians. We can talk more about it. We can do a show about that anyway. Yep, please please let me know what you want. Now in terms of today's show, you can

ask questions again, you can ask questions about anything. I will get priority in terms of time to the questions about healthcare. So any questions you have about health care, health care policy comparison to other countries, NHS, I don't know that much about I don't know Switzerland or some of these other countries. That have highbrid systems. But I know something about the NHS, a little bit about the

Canadian system, a little bit about the Israeli system. Those are the international systems I know of I know about I don't know that much about the other systems other than a few things that I'll say at the begin at the beginning of the show here, all right, I think we've kind of summarized it. Yeah, we can do one on again laws. Yeah, you know, whoever puts the money up, that's what we'll do. This is market driven. The one book show is very market driven. Whoever puts

up the money that not. You don't get a say in what positions I will take, on, what opinions I hold on, what recommendations I make. But in terms of the broad topics, yeah, we can do that. We can do that, all right, So let us start with healthcare a gain. Super chat is open. We have a regular goal and this is probably go long, just because I have a lot to say. Of course, there might not be any questions, so it might be showed and what

else that I want to say. Yeah, you get to ask the questions and feel free to ask about anything, but priority will be given to healthcare. So one thing, one thing I think everybody can agree about when it comes to healthcare is that it seems that pretty much nobody is happy. Nobody is happy with the system. Now, it might be true that healthcare right now is not a big issue politically. It's not top priority for Trump,

it's not top priority, wasn't top priority for Biden. Since Obamacare, there was some movement to abolish Obama, kay, But other than that, there's been very little, very little really uh excitement, and very little emphasis, very little focus on healthcare over the last few administrations. And the system just keeps chugging along. We'll talk about what that means, but it seems it just it just keeps going and nobody wants to touch it.

And a big part of nobody wants to touch it is everybody knows the complexity of doing anything with healthcare. And more importantly than the complexity for this purpose is the number of pressure groups, the number of the number of people who are who have an opinion, who have a view, who are going to fight tooth and nail for whatever it is for their piece of the healthcare pie, if you will, So that the amount of pressure group

politics here is as bad as probably in finance. Uh and uh and and really really really horrific, much worse than immigration or almost every other topic because of the because of the complexity and the scale of this issue. Right, the scale. While nobody's unhappy with the system, healthcare in the United States is massive, right, it is a four trillion dollar expenditure a year. It constitutes seven last constituents I think twenty three seventeen point six percent of GDP,

A massive portion of government spending. Government spending goes to you know, goes to healthcare, Medicare and Medicaid, a huge chunk a two trillion dollars of government expenditures. So in a you know, twenty eight trillion dollar economy, we spend about four trillion twenty seven trillion dollar economy, twenty eight trillion dollar economy, you spent about four trillion on healthcare. Think about for trillion, and healthcare as ninety thousand dollars

per person. I mean, it's huge, It employs millions of people. It is a massive industry which nobody is excited about. Nobody is particularly happy with. I mean, you hear lots of complaints. It's super expensive and as a percent of GDP seventeen point six is the highest I think in a developed goal. I don't know in the world, probably in the world as a percent of GDP spending on healthcare, and you know, other countries are close that are twelve thirteen, fourteen.

Nobody even comes close to the seventeen point six. And yet the argument is I'm not saying this is true, but the argument is that outcomes are not that much better. That as life expectancy, the broadest outcome that people measure, is lower in the United States than most of the developed world. Now that number is cheating. There's a lot of cheating going on with numbers generally to make different points.

Life expectancy in the United States is lower than the rest of the world at birth, and that's because of two things. Basically, one, it is the case that infant mortality mortality of childbirth is higher in the United States than the rest of the developing world. But the big difference in life expectancy at birth is unrelated to healthcare.

It's related to drugs, suicide, crime, traffic accidents, which all as a percent of the population are very high in the United States compared to the rest of the world and are actually the things that cause did I say rug overdoses, If not, I should have drug overdoses have led to decline in life expectance. You should also say that a big issue here is obesity, which the United States. I mean, the UK is pretty bad, but I think the United States is still the most obese country in

the world. Maybe the UK's was, maybe there are a few other places, but generally it's really really bad here. So if you take into account all those things that have nothing to do with the delivery of healthcare, they're the ones that have an impact on life expectancy. Interesting fact, life expectancy of Americans who reach seventy years old, So life expectancy of people who reach seventy years old higher in the United States than anywhere else in the developed world.

So once you can take out all the other factors and just folk us in a sense of healthcare delivery, we keep people alive, really really well. People us complaining that healthcare in the United States is not universal, not everybody has access to it, not everybody can afford it. It's because it's so expensive. It's not just expensive kind

of a national account. It's expensive for individuals and if they are people who supposedly can't afford it, and as a consequence, you know, it is not universal, and they are harvest stories of people who don't get healthcare in the United States dying, and if you go outside the United States, in the UK and in Europe, everybody believes that basically people are dying in the streets on a regular basis for lack of healthcare in the United States.

It's really the amount of mythology that exists in the UK and in Europe about the healthcare system in the US is astounding. Add to that the fact that people get denied health insurance and people upset about that, and that again there's a huge mythology out there that many, many, many many people in US die or do not get treated because they're denied coverage. You know, I got so many stories from my debate in Cambridge where the audience was like, you know, I would have never got treated

for this and this in the United States. I was born with this disease. Now would have never got treated. I was born with this, you know, handicap, and I would have never got treated because I couldn't afford it. You know, in the in the United States, which is mostly ninety nine percent of it is perc It's just not true. And then finally, the one big problem that exists with god costs, which is real. I mean the US in many respects it's expensive. But we'll get to

whether that's real or not. But the one way which it's really expensive and is that basically healthcare costs of bankrupting the federal budget. In other words, Medicare and Medicaid are unsustainable. Spending on Medicaid and Medicaid is just an unbelievable, unbelievably expensive and not sustainable if you look into the future, something has to give. Given the amount of revenue the United States brings in, it cannot sustain medicaan Medicaid spending

at the rates that they are. So, you know, so we do have we do have an obesity problem, which is blamed on the healthcare system. We have a service denial problem, which is blamed on what we call health insurance. There is a quality of service. Primarily people can plaining about the very little time they get to spend with doctors. Doctors complain about the very little time they have to

spend with patients. There's very little, if any preventive care or very little of it, and there's very little emphasis on it. Physician compensation is actually has declined in real terms or being stagnant, and the quality of life in terms of the quality of the enjoyment of the profession, in terms of time with patient time, solving problems of physicians and health care healthcare people in the healthcare system is down. The system has no real transparency. We have

we don't know how things are going to cost. We don't know exactly what we're consuming, how much, how much we're consuming. There is complete mystery about healthcare costs from the consumer's perspective. So all of these are many many other things are real costs are real problems in the United States, and and people are frustrated and and and people upset. They're insurance premiums. They are paid by primarily

the employers. We'll get to that, but you know, they pay an ever growing portion of it, and it's expensive. And you know, as we'll see, there all kinds of distortions and perversions that are caused because of the system the way it's comprised. That just creates uncertain the angst and frustration. So what is it about the system as

his gifts today. What is it about the policy, the healthcare policy in the United States as it is today that that has caused the system to be as frustrating and as upsetting the people as it is as it is. So let's let's go over kind of the way the healthcare system is structured today and the way this leads to these frustrations. So let's I think that we should start with kind of the way most of us experience the healthcare system, and the way most of us experience

the healthcare system is through the purchase of insurance. And while insurance is not the delivery of healthcare, insurance is the way we fund healthcare, and the insurance dictates the large extent what kind of healthcare we actually get. So we need to step back here and talk about what insurance is. Insurance is real. Insurance is something that covers you for where unexpect acted and you know, significantly costly events.

So insurance is a mechanism to protect you from things that are unexpected, you know, a known that is there's a huge amount of uncertainty around when they will happen, if they will happen, and where the cost could be very high. So think about it what's the probability your house will burn down? It's very low. Do you know when it will happen. No, you can't predict when it will happen. What are the financial consequences of your house

bringing down? Pretty catastrophic, it's really bad. It's a lot of money. Think about auto insurance. We write our insurance not for our regular service. Doesn't cover up kind of the three thousand mile or whatever. It doesn't cover oil changes. You know, for the most part, it doesn't even cover like little dents and bumps and stuff like that. It covers you really for when you have a significant accident,

and the cost it can be thousands of dollars. Now, it's not as expensive as a fire burning down your home. The probability is higher that you get into a car accident than your home burns down, and it's less expensive, but it's still relative to the cost of the car, a lot of money. So you buy insurance to cover that. You don't cover the little bumps and the little things, and you don't cover maintenance. Life insurance, you don't know when you're gonna die. Dying, let's say when you buy

life insurance. Typically a good age to buy life insurance is when you start a family and you've got dependence, and I want to make sure that if you drop dead, they have some money, and so you want to buy life insurance to cover you from age I don't know, thirty to sixty something like that. Those thirty years is while you've got a family and that dependent on you, and you want to be able to if you die, they get a million dollars or whatever. You want to

be able to cover it. You don't know when it's going to happen. What's the probability you die between thirty and sixty pretty low, and it's catastrophic. It's catastrophic. And think about business interruption insurance, Think about all the kinds of business insurance. Think about maritime insurance. The ship, you know sinks, pretty low, probability, uncertainty about it, catastrophic. And yet health insurance doesn't work that way. And it doesn't

work that way because it's really not insurance. It's really not insurance. It's a form of risk pooling, it's a form of redistribution of wealth. But we really should not call it insurance. It doesn't have the characteristics of insurance. If I have a cold and I go to the doctor. You know, that's gonna cost me fifty dollars, maybe one hundred dollars, maybe maybe one hundred and fifty dollars if you have a relatively expensive doctor. It's not catastrophic. It's

pretty common to get a cold. I get one once a year, pretty common to get a cold or to get the flu. And yet we cover uh. And you know, if you if you have you know, diabetes and you have to get you know, insulin or you have to get diabetes drugs or whatever. And now it's a constant cost forever, insurance covers it. You know, we cover, we cover things. You know, we cover a relatively minor, relatively

low cost recurring expected events with this insurance. So it's not And of course we don't even buy the insurance. We might choose if our employer has options, we might choose between different health insurance plans, but we're not really buying them. Our employer is buying them, and employers buying them, you know, they and you know, they're the ones who contract have a contract with the life with the health insurance. And one of the one of.

it really isn't insurance. We have a third party system where our employers get us insurance and then we get to consume healthcare and basically bility to the insurance company. I mean, this creates all kinds of model houses, It creates over consumption, It creates a system by which we don't care about the cost of insurance. By the way, the cost of insurance has nothing to do with your health. The other thing about insurance is we've talked about this

in the past. In fire insurance, the insurance company determines the premium based on, for example, how likely it is that there will be a fire in your area that your house will be caught up into. So some areas in California that are very very very very high a fire insurance because the likelihood of a fire is relatively high. Other places really cheap because the likelihood of a fire

reaching you is very low. Same with flood insurance or the flood insurance and earthquake insurance very distorted markets, but when they functioned where you were, the risk that you would the risk that you are susceptible to this catastrophe is taking into acount in your premium. Health insurance companies don't assess the risk of you receiving a disease. For example, you and your coworker, you might be at the same age, but he might be, I don't know, one hundred pounds

heavier than you. Now the fact that he's one hundred pounds heavier than you makes him susceptible to diabetes. Diabetes makes them susceptible to heart disease, which you know, and even cancer. It makes them susceptible to potentially all time is at a young age insurance company, they don't care. I mean maybe they care, but the system is not structured to take that into acount. None of that is relevant. Indeed, it's illegal for them to take any of that into account.

You might have a gene that makes you most susceptible to certain cancers. They can't take that into account. So they're pricing off of a pool where they're basically estimating the relatively ages of the people in that pool. But that's really the only in sex. Age and sex are the only parameters they can play with, and they figure some out, be some or not, and they come up with an average price, and then everybody pays basically. You know, I think there's an age adjustment, but everybody pays a

price based on your age, and that's it. So again, non insurance. What we have today in the United States is a mechanism by which we redistribute wealth, We distribute health expenditures from healthy to sick, from young to old. But don't call it insurance. I mean, we call it insurance because that's every that's what everybody calls it, and it's the way it's called. But it is not insurance, not by any financial measure of it. It is a polling of risk. It's a pulling of risk without you know,

to some extent, a blind pool of risk. And by the way, so now why do we do that? Well, I don't want to get into the entire history of it, but the basic idea is that employers versus employees. Employers have an advantage in buying health insurance. If an employer buys health insurance, the health insurance premiums are tax deductible. If you, as an individual buy health insurance, your health

insurance premiums are not tax deductible. So you have a huge advantage in letting the employer buy the health insurance for you because they do it with pre tax dollars and if you did it, you would be doing it with after tax dollars. So again that provides a massive incentive for employers to buy the health insurance. And a lot of employees don't even buy insurance. They have insurance companies administer what they call insurance, and they're really in

a sense self insuring. They're creating reserves, financial reserves, and it's their money that is paying out. It's not the insurance company that pays the money out for your healthcare, but the company that the company does. So the fact that we have an employer based system. The fact that our system, by regulation is not an insurance system but a pooling of risk jumiative system is at the core, I'd say, one of the two cores of really all

the problems that we have today in healthcare. The other the other is the about fifty percent, actually it's over fifty percent of all healthcare expenditures are spent by the government. Basically the government covers through its so called insurance policies, right Medicare and Medicaid. The government covers one hundred and fifty million Americans. I mean, people say, you don't have a single payer healthcare system, or one hundred and fifty

million Americans have a government healthcare system. That's about ninety million people. Ninety I didn't realize the numbers this week. Ninety million people are on Medicaid. Sorry, yes, Medicaid that is healthcare for people who cannot afford insurance. This is supposed to healthcare for the poor. That includes CHIP, which is the healthcare for children whose parents cannot afford to buy insurance. And so that's ninety million and sixty something million.

So it's over one hundred and fifty million, sixty something million people on Medicare, which is basically everybody over the age of sixty five, no matter whether you can afford it or not, everybody over sixty five gets Medicare, and that number will grow to over seventy million by twenty thirty two.

quite half, but it's forty percent thirty five. Forty percent is all government and fifty percent of expenditures because when you spend the most on healthcare when you're old, that's all covered by government, all covered by government, all covered by government, right because Medicare pays for sixty five and over. So you have a situation where fifty cents of every dollar spent on healthcare, actually more than fifty cents is covered is government spenditure. So we don't have a private system.

We have a pseudo insurance that's non insurance system, and we have a government system. Those are the two alternatives, and the government system dictates a lot because it's it's massive. So let's take Medicare. Medicare represents sixty something sixty let's say sixty two million people, all eight sixty five huge consumers of healthcare, and they're all getting hiperplacements and bipus

surgeries and cancer treatment. Right, And so when doctors and hospitals a billion for all those treatments, they are facing this kind of monopoly. There's only one entity representing people over sixty five. And so who has the pricing power in that relationship, Well, clearly the government does. So the government can dictate prices. The government can drive prices down on some things. And by driving prices down, for example, you know, doctors get very little money from Medicare for

complicated procedures. It's sometimes hard to believe how little money they get per procedure from Medicare. And hospitals have to negotiate with Medicare, and Medicare drives prices down. And now hospitals and doctors and everybody else still have to make a living. They still have to make a profit. And there's a sense in which they make the profit off of driving up the price for private health private insurance.

For the insurance it's outside the Medicare system. So you get a system in which the private so called insurance is subsidizing Medicare and Medicaid. And of course one of the big controversies right now is should Medicare and Medicaid be able to gootiate drug prices, because if they can negotiate drug prices, they can lower drug prices dramatically, like European countries have and like Canadian system has by basically, you know, being the dominant buyer of a drug in

the economy. And if they can drive down prices dramatically, either drug companies now you know they they their profitability plummets. They which reduces their availability of capital for them, which is useless, R and D and all the other consequences or drug sales to private individuals through their so called the insurance policies have to go up. Something has to give, right,

the money has to come from somewhere. And if the government's going to squeeze drug companies as so many people want it, Bide administration has already started the process to woulds that, and Trump is indicated he would like to continue, then you know drug drug companies are going to be profitability is going to be squeezed completely and given the cost of drugs and and and the length of development and expense of developing them. What happens then, what happens then.

So the fact that the government is such a big buyer of healthcare services is a major, major, major problem which UH basically distorts distorts the pricing, UH, the pricing of healthcare in the United States. As a consequence of that, what you see is massive cost subsidization, healthy subsidizing the sick. We talked about that. The subsidizing the old, We've talked about that again. We're all subsidizing the Medicaid, Medicaid that the old get after sixty five, those of us who

are not yet sixty five. I'm not quite there. I'm almost there. And insurance companies or the so called insurance framework, it's not the companies, it's the people who pay the insurance of subsidizing government programs, huge amount of cost oftization, and it's really hard to keep track of it. I mean, I don't think I don't know that anybody has in terms of the actual numbers, but keeping track of it is almost impossible because it's going on all the time,

and it's super complex. Now, top all of that off with the fact that healthcare is heavily, heavily regulated. So these pseudo insurance policies, what they offer, how they offer is unbelievably regulated. What you can and cannot offer, what the policies, the kind of deductibles, the kind of coverages. Now most of that regulation, not all of it, but most of that regulation is not at the state level.

But that means they're fifty different types of regulation. It also means that because of that, if I live in California, I cannot buy a health insurance policy from Nevada. I can only buy it in California because health insurance is regulated at the state level, and you cannot buy across state lines health insurance, so there's no real competition. So it's heavily regulate the insurance level. I mean every aspect

of what you can buy. I mean, if you look at the Obamacare exchanges, the policies all look very similar, and they look very similar because there's only a range in which they can play around. They have to cover I don't know, psychological care, they have to cover pregnancy, they have to cover all kinds of things. In California, alternative healthcare like acupuncture has to be covered. All kinds of stuff like that, and then the actables cannot be

too high. You cannot get catastrophic health insurance. It's very difficult to find a state where you can actually just buy catastrophic health insurance. We'll get to that. That's insurance. But then everything about the delivery of healthcare is regulated. Hospitals,

massive regulations on hospitals. We saw that during COVID. And isn't it interesting that given the failure during COVID, the you know, the lack of capacity, the lack of communication, the bad policies coming down from government visa v. COVID, that healthcare there was really no reform. There's really no lessons learned, not just about how to deal with the pandemic, but maybe there's something in our healthcare system that is not working right. For example, you remember there were hospital

bed shortages. Why is that, Well, it turns out the state governments regulate how many beds you can have in the hospital, and if you want to expand, you have to get permissioned because they're looking at something about competition within a particular band. In the nineteen fifties, there was passed a law that said that within every certain radius there has to be a hospital. So lots and lots

of hospital were built. Some of that has gone away, but again, you know where hospitals are, how many beds they have, what kind of services, for example, emergency services are not they can provide, all regulated, all controlled by government,

heavily heavily regulated. And of course what the government, what a doctor can prescribe you, what kind of drugs are available, the whole issue of drugs, whole issue drugs massively regulated, massively controlled by government, the FDA, and the whole process of getting drugs to you. The whole reason it's so expensive and it takes so long is because of the extent of regulations. And then finally, well not finally, because I think there's a lot more than I'm not even

getting to. But there's the supply of medical staff is regulated, is controlled, doctors, nurses, people who working in hospitals. Licensing laws very across states but are pretty stringent. They are restricted restrictions and funding for medical schools that can increase the number of doctors or decrease the number of doctors, depending on decisions that are made in terms of funding

medical schools. And then there's immigration, the fact that doctors who are highly qualified, who are being trained in the best universities in the world outside the United States and licensed in those other countries, and not a lot of work in the United States and cannot get immigration visas. So it's very difficult to get immigration visas to come to the US to work here on a permanent basis.

So we've got a a financing system that is completely messed up because it's not real insurance, and it creates mal hazard, which means over consumption. It creates distortions of pricing where we as consumers don't know and don't care

how much any procedure costs. We just don't care, as compared for example, to lask which is not covered by insurance, where we do care how much it costs and you know, or what is the other one, and prices have come down, by the way, and plastic surgery, which is not typically covered with insurance and where prices of us come down. And there's massive innovation in both LASY or health eye health, different different aspects of improving I say, massive improvements dropping costs,

and certainly that's true of plastic surgery. Lots of options, real competition, and we as consumers get to decide what to do, who to do it with, and so on. All right, so I've laid out kind of the system the way it is now. This is not this is just a fraction of it. Right. We haven't got into, you know, how drugs are delivered through. Uh these you know entities that sit between pharma and your pharmaceutical and

your pharmacy. I just forgot the acronym just slipped out of my mind, right, pb PBS's maybe anyway, and they sit in between. I think most of them our owned now by insurance companies. I think one may be owned by one of the pharmacies. But these entities that are supposed to make things more efficient but have created massive

complexity within the drug delivery and drug pricing. You know, we haven't talked about, you know, all the other ways in which regulations drive and drive all kinds of distortions and perversions within the healthcare system. Pharmacy benefits managers p b MS not pb SspB MS, thank you. The complexity is massive. Now, a free market would be pretty complex. We'd have actually more options, but it would be simpler for you as a consumer. All Right, what should be

a goal in reforming a healthcare system. We want a system that provides consumers with choices regarding treatment and cost, that maximizes individual health outcomes and avoids both personal and government bankruptcy. Right, So, healthcare system that provides consumers consumers of health care with choices regarding treatment and cost, maximizes individual health outcome and avoids what personal government bankruptcy. And add to this, maximizes the freedom of doctors to exercise

their profession based on their judgment. And that's something we also haven't talked that much about the fact that so much of the system, so much of what doctors are left doing in what is covered and what is not covered, and what is permitted and was not permitted and soon is dictated by Medicare and Medicaid and be insurance companies, and so much of that is just it's much easier just to regimen in certain convey mentional medical treatments and

and and be be conservative about, you know, not trying new stuff, not being radical in in in how one delivers services, because we've got a particular way in which this is financed. So for example, the pter T model where you're not really paying him like you do a part you pay him a retainer if you will, or the concierge doctor model is not covered by these insurance policies. Most of us pay insurance, and then we have these concierge doctors that we have to pay out of pocket.

It's double the money. You know, you're, you're, It's just it's just overly cumbersome, overly complex, and way overly expensive. I have so many would done dincies in the healthcare coverage that I have. It is ridiculous because I have concierge doctors. You know, I have a very expensive health insurance policy because because anyway, I have a very experienceive of health insurance policy and I pay out of pocket

for a lot of things. And yet I have this expensive insurance policy that just doesn't cover all the things that I value and that I pay out of pocket. So, you know, this is the health care system we have. Why do we have it? Why is the healthcare system the way it is? Why is goverment so immersed in healthcare? And why have we taken decisions away from individuals? Now, you can take an historical perspective on this and see all the different points in which this was created by

many can't MEDICAI a relatively new in the nineteen sixties. Somehow, old people and poor people survived in the health care system up until the nineteen sixties, yet Medicare and Medicaid were instituted. You know, the whole idea of employer based healthcare was a way was introduced during the World War Two as a way for companies who faced price controls over wages increase benefits to their employees as a way

of giving them a raise. They weren't allowed to give them an actual raise, so they gave them an added benefits and then that was institutionalized in the nineteen fifties early fifties by giving them attacks deduction on that benefit. But just imagine if during World War Two we didn't have a cap on wages, we didn't have price control on wages, then we wouldn't have maybe the insurer based the employer based so called insurance system that we have today.

So a lot of this happens incrementally, slowly, it builds, and then as we know, every government's invention creates problems that then lead to more govermnent intervention that creates problem to the least, the more goverment intervention, and we get this stacking on top one on top of the other. You see this with Medicare and the Medicare pod D. You see this with healthcare, and all the regulations are like this. I have great examples on this from finance.

But it's the same is true in healthcare. But what is excuse given for why the government plays such a big role in healthcare? Why it basically covers the expenses of one hundred and fifty million Americans, Why it's you know, it's very difficult if you want to buy individual health care. Why the government makes it so difficult for you? And why the choices are so constrained, particularly at the insurance level. Right insurance level, we have very very limited, limited options.

I will say this. You know Americans want choices. And one way you can and tell that we want choices is the failure of the kind of the PPO model. This is the PPP model. The PPO model is a model which you paid less for the so called insurance, but you got fewer choices in terms of doctors and hospitals and facilities to treat you. The sorry, that's the HMO model, and then that's HMO model. Get fewer choices in doctors, few choices in hospitals, fewer choices in places

to treat you. The PPO model is wide choices. And while the h model was popular what twenty twenty something years ago, maybe thirty years ago, it pretty much shrunk dramatically because people didn't choose it. People didn't like it, They didn't like to speak to choices. People want choices. So the government keeps finding ways to reduce the choices while while we were giving us the tense that we still have them, given us the pretense we still have them.

And why, well, I hear these arguments all the time, why we can't have more free markets in healthcare? There's asymmetrical information. You know, you don't know what's good for you. You can't judge a good doctor and a baghdad. You can't judge what procedure you should take. There's too much, you know, the difference in knowledge between you and the doctor, or you and the providers of healthcare is too large.

It's just too large. Healthcare is too expensive, and if we don't provide it as a government, you'll all go bankrupt. Healthcare will just collapse if the government doesn't provide it for you. There's no mechanism. The market does not have a mechanism by which to allow you. So people just die, right you. Poor people won't get any health care, they'll just die. Old people will just not be able to afford Who can afford a cancer treatment? It costs millions

of dollars some cancer treatments. So it's too expensive and it's way too complicated. So which goes through with the asymmetric confirmation. In other words, you're not smart enough most of you, and you're not responsible enough. A lot of you won't buy insurance, you'll buy the wrong insurance, you'll buy too little insurancy. Whatever. And then finally, the profit motive. The profit motive is a really bad incentive in healthcare. It's going to lead people to try to you know,

like everywhere. How can you trust the profit motive? The profit motive is about greed, and greed will lead people to undertreat you. As if that happens anywhere else in markets, like in food, to get rotten food because of the farmer's greed. Food is privatized, it's not provided by the government. Do we get a lack of variety in food because of the farmer's greed. It's completely nuts, completely nuts. So profit is an incentivizer to increase quality, actually reduce costs,

it's to innovate. Profit is to provide great service. That's what the profit motive actually does. But people don't believe that. And then finally, and I think this is important. Healthcare now is perceived as a right. I must have it because I need it, because we all need it. We all need it, will require healthcare at some point in our lives. Therefore we must have it. There's a more

responsibility for it. There's a responsibility to take care of anybody, everybody, and therefore the government must step in because we wouldn't fulfill them our responsibility otherwise, altruism demands it. And ultimately it boils down to a really emotional argument. And the consequence of this, of course, costs are indeed high. Some people get so its denial, but generally we're not exposed

to the best alternatives. Necessarily, you need to invest a lot in figuring out what's going on if you are sick and you need treatment, complete subversion of customer from prices. There's from prices, this massive mal hazard. There's just a lot of unnecessary complexity and opaqueness and confusion, not just among customers patients, but among doctors as well. I mean, think about how much time and effort doctors today put

into the paperwork. How many people they have to hire to fill out paperwork, paperwork, everything's paperwork to get reimbursed, and the time wasted waiting for reimbursements, and the effort exists. You know, so many doctors get MBA's not so much because they want to grow their business, but because they just need to survive. They need to know some accounting, they need to know some stuff because it's become so complicated.

So they're real destructive consequences. And a lot of this has to do with destructive consequences the doctors, and I think doctors feel like they become bureaucrats. The producers of healthcare feel like they become bureaucrats. The producers of healthcare feel like, you know, they're not being compensated appropriately to what they're doing. And a lot of people leave healthcare, the people entering healthcare of a lower quality. Generally, healthcare

is less rewarding. It's as it becomes more bureaucratized. And again, the talent is the talent pool is smaller. Fewer people go in for the right reasons and all kinds of distinctions and medical schools and so on, but just from a pure economic perspective, fewer people are going to go in because more bureaucratic, less opportunity to innovate, and expensive.

Medical school is expensive, and you know, salaries income stagnant, and you know, then think about drug companies and think about medical device companies, and think about all of that and the degree to which we regulate and control all of that. To that degree, we don't get massive innovations, new products. I mean, it's stunning and amazing and heartwarming, and you know, just amazing that we get as much innovation as we do. I mean, we get huge amounts

of innovation. And yet imagine what we could get if we didn't control and regulate and mandate and so on. And I'm not even getting you know, one of the issues with healthcare that we should discuss but we won't discuss today is medical research, which is government dominated and it is far from optimal. And it's a whole other topic. Think about the NH, the NHS and NIH National Answer for Health and all the money that the government gives out in grants and so on, not an efficient productive

you know, method or outcome. All right, So we've described the system as it is, at least parts of it. Again, I'm sure there are big holes here. Let's talk about what we can do to fix it. And I think that the two things that have to happen in order to fix the system, and the main thing is the main thing is the main thing one has to do is to reduce the involvement of government in health care. To reduce the involvement in government healthcare in every dimension.

So we need to reduce the amount of government regulation of health care. We need to reduce the amount of government regulation of insurance, health insurance. We need to reduce the moment of government in actually funding health care, Medicare, Medicare, each one of those is huge, each one of those all to some extended related And of course we need a change tax policy to change the kind of incentives in terms of who's buying insurance. So and I'd say

that's part of regulation of health insurance. So we need to reduce the eliminated regulation of healthcare providers. We need to reduce the eliminate regulation of health insurance. And we need to reduce and ultimately eliminate government as a provider of healthcare direct healthcare financing. Now, all of that is a lot. We're talking about seventeen point six percent of GDP.

We're talking about the largest single industry out there again, employees millions and millions of people, and spends for trillion dollars. And we want to do it all in a way that does not bankrupt people, that does not have people who are sick dying in the streets, that does not disrupt medical innovation, that does not disrupt the ability of doctors to do their job. So we want to make the transition as smooth as possible. Not that they're no costs.

Whenever you have a system like this and you're trying to make it more free, there are costs of transitioning because so much infrastructure is built around this. The disrupting it is going to some Pospitals might go out of business, some doctors might go, some insurance companies might go. There's going to be a restructure, a restructure, a repositioning of the whole system. All right, So let's let's think about

how to do this. Let's talk about let's take step by step Step one is we want to phase out the employer provided healthcare. We want to get employers out of the business of health care, of out of funding it, financing it, buying it, whatever, out of it. And we want to move to a system where individuals own their own health insurance policies. And we'll see that if we move towards individually owned insurance policies, that will also be an opportunity to move towards real insurance. We want to

at the same time completely deregulate the insurance marketplace. Now I don't know how you do this because the insurance marketplace is governed state by state. Now you could federalize it. You could say, states, you cannot regulate insurance anymore. It's going to happen in the state. It's going to happen. You know, we're not going to regulate insurance. Oh, here are a few standards by which you can regulate, but that means ninety percent of what you're regulating goes away.

So you can't maindate what coverage, you can't mandate what deductibles. You can mandate all these things, or one alternative if you don't want to completely trample on so called on the states is to say, is to have a federal law that basically says you can buy insurance in any state and create competition among the states, and who can deregulate the fastest, who can deregulate the fastest, so you can have competition between states. So I'm open to either

one of those. I ideally I would love to see all state regulations go away, the regulations about the kind of policies, the type of policies, what can be offered, and maybe a federal law could do that. And if it can, then it should. I'm not sure the Streame quote would accept it, but it should. It should try to get rid of state level regulations. In that sense, you should federalize it. It was done in banking there were state level regulations that were basically nationalized and eliminated.

So we need to do that. How do you move to individual owned healthcare policies, Well, you need to stop giving companies a tax deduction on healthcare expenditures. They cannot they cannot spend money, they cannot, sorry, they cannot get it to tax deduction, and then offer individuals a tax deduction at least in the short run. Like this could be a policy that is phased out over time, because I don't particularly like giving people deductions on taxes, because

I like really really simple taxes with no deductions. But to solve the problem that we have, and maybe this would also be done in education for a decade, let's say you give people the ability to deduct their insurance premiums from the taxes at the individual level, not at

the corporate level, not at the business level. Businesses have to pay taxes, cannot deduct insurance costs, and nows you shift the incentive to individuals, and for example, what about individuals who don't itemize, give them a deduction in spite of that. There are ways to do it right. One way to do that is, you know, to have a

medical saving account. Medical saving accounts allow you to put money pre tax into an account and use that money for healthcare, including insurance, and now you're not having to deduct anything from your taxes other than the money that you put into that account, which is not going to be taxed. That's a simple way to do this. So medical saving accounts should become universal. Everybody should have availability

to them. They should be unlimited. Let individuals make decisions about how much money they want to put into a medical saving account. It doesn't make sense to put in you know, more than what you're going to use for healthcare. You should be able to roll them over from year to year. So this can become basically a way for you to save money for healthcare emergencies or for expected significant healthcare costs come in the future, and you should be able to use that money to buy health insurance.

Now with a system like this where I have a vehicle in which I can save money for healthcare expenditures, a system where I can do this in a pre tax manner, a system where I own the insurance policy that I'm buying, and I own this account where I'm saving money to cover my expenses in a sense self insuring. What it makes sense for individuals to do, and what I think individuals would do is actually buy real insurance, not a risk pool, but real insurance. And what that

insurance would be would be insurance against catastrophic laws. This would be insurance that would cover you if you had to have surgery, or if you had a heart attack, or if you had cancer, or it would cover certain expenses if you develop diabetes. Maybe not all the expenses maybe not the recurring expenses that you can expect, but

some of the dramatic, big ones. So I mean it would be a competitive market in which different companies would offer different coverages and the market would figure out what made sense and what didn't make sense. You could imagine insurance policies that this is the way you could take care of what do you call it a PI existing condition? Insurance policies that covered you for life price to today based on your health today, had a payment schedule into it for the rest of your life, and that covered

just these catastrophic losses. You can imagine all kinds of things developing, right, you know, insurance policies that encouraged you to take care of yourself, gave you discounts when you exercised, and actually maybe insurance policies that actually tracked your fitness monitors that actually encouraged you to wear them. I know, privacy concerns. I don't care about privacy. If I'm going to get a discount, I want my insurance company to know how much I exercise. And maybe, you know, you

could even take photos of what you eat. I don't know, But the point is you'd get innovation you'd get competition, and you'd get real insurance, and you get insurance that does its job. If it was good insurance, it would do its job to lower your risk of actually incurring

the catastrophic risk. Right, so, fire insurance insurance company might come to the house they certainly do this with big expenses like industrial insurance, and say, look, we would actually lower your cost of insurance if you did these five things to make your home more fireproof. For example, I remember we changed the type of tiling on our roof and the kind of insulation in our attic. That actually lowered a cost of home insurance. Why because the house

was less likely to burn down. Well, imagine again the insurance companies, we're willing to lower your health insurance because you let's even say you are taking a statin that lowers your a POB to a level that makes it very unlikely that you will get a heart attack, And the insurance company might say, you know, we'll even now. Now it turns out that statins cost almost nothing, but some of these other mechanisms are lower condition are quite expensive.

I mean, insurance company might even say, you know, yeah, we'll cover that cost because you know, because we're going to have you as a client for many years, and it lowers the chances of you actually needing this catastrophic I don't know. My point is you'd get innovative products. Hospitals might provide insurance, Doctors associations might provide different types

of insurance. I mean, we might be able to move into what p dot T calls healthcare three point zero, which is a healthcare much more focused on prevention than on treatment, and to fund and the odience everybody and everything, and the incentives both of the doctors and the customers

towards prevention rather than towards just treating you when you're sick. So, once we get the employers out of it, and we get individuals to buy their own policies, and we provide them with an incentive to put money aside for their health care through a tax deduction MSA, uh medical saving incomes, and an incentive to buy some kind of insurance, but any kind of insurance, you've solved the huge part of the American healthcare system, you know, And then I am

buying healthcare. I'm going to my doctor and saying, okay, you know, how much does it cost to fuse my back if I need black back fusion, what are the alternatives? How much did they cost? What are the outcomes? All right, let's sit down and figure out what I should do. What is insurance going to cover? Will insurance cover any of it? And if so, what of it will it cover? Given its catastrophic nature? Does this coount? All of that

would then go into decision making. Now, this requires people to actually be engaged, to be involved, or you know, just like it could be that just like we have financial advisors where we say, you know, I don't want to I don't want to think about how to invest my money. It's too difficult. I'm going to hire somebody. I'm going to do my research and hire the best person I can and then basically they can invest my money and then good someone how it's going to be invested.

Maybe we have healthcare consultants healthcare advisors who when we have healthcare decisions that are really complex and time consuming, we hire them to come in and provide us with all the facts and help us make the right decisions. I don't know. That's the beauty of markets whenever they are asymmetries of information, and they're huge in medcare healthcare, no question, Whole sectors the economy develop, new professions develop

in order to mitigate the asymmetry. So when can only imagine the kind of products, the kind of innovations that would happen to deal with the complexities of healthcare. And maybe that consultant is just how Maybe that consultant is simply our physician, how our general physician. Maybe you actually maybe that's generally part of their will is to help us navigate. It's to organize what specialists are saying, and it's to sit down with us and say, Okay, here

are the options, and here's what possible. And maybe and one would expect, given that I am paying, that they would start treating me a lot better, spending more time with me, and that the general physician would become much more of a consultant, coordinating all aspects of my care with specialists and hospitals and clinics. Then just a guy I go see for a general check up and go to get get get a couple of aspens when I'm

not feeling well. So imagine your primary care physician becoming that a real consultant to you, somebody who is really there to work with you through a healthcare plan, how to avoid disease, how to stay healthy, and then when you do something does happen, how to maneuver, how to deal with the complexities of the system. All right, so if we phase out, you got to phase out, uh the end, and you got to do it over time.

You can't do it all at once. I would start by offering mssas to everybody, and then I would basically put a sunset a year from now on the tax addictability of health costs. So first off of them mssas. First, give everybody an opportunity off open a medical saving accounts. Then tell employers you're not going to get the text deduction anymore. Not going to get the text deduction anymore.

You've got a year, two years to adjust, to adapt, and to educate your employees to the fact that you know they will get a better deal if they buy insurance through the MSA, through the medical saving income. And what what happen is you'll get insurance markets developing, you know,

a little bit like Obamacare, but better, more efficient. We'll get to Obamacare later, but so a vast majority of working adults get their healthcare today through the employers that would go away, and they'd start getting it personally in a big chunk of the healthcare system would suddenly be privatized. Now, if you couple that with real deregulation of hospitals, real deregulation of doctors, real deregulation starting of drugs, massive benefits.

But you still need to deal with Medicaid Medicare. And this is not easy because that's so big and so much depends. So many people depend on it, so many people are being conditioned to depend on it. You can just take it away tomorrow. Everybody has pre existing conditions. It would be very, very difficult for them to fund it. People have not saved for their healthcare when they're old, So let's just start with Medicare. So I think Medicare

needs to be phased out. It needs to be phased out over time, and it might take a generation to phase it out completely. The best idea I've seen around phasing out Medicare is to move Medicare away from health care, to make it a purely a system that subsidizes healthy shaans. So Medica should stop writing checks to hospitals for drugs

for anything. Medica should move to basically a voucher system, a voucere system that allows the elderly, anybody over sixty five to buy health care and to buy catastrophic insurance. So basically, take what we spend today per person on Medicare, have them all open up in medical saving accounts and put the money into the medical Saving acount The government literally puts the money into their saving accounts, and they can use that money to buy insurance and to pay

for health care spending that they might have. This is going to be incredibly expensive because but Medicare is already pretty expensive, so it would stay expensive. But what you would do is every year, maybe two years, the amount of money that went into this medical saving counts would

be slightly lower for new people entering the system. So for old people you would guarantee, I'm just making numbers up now, you'd guarantee every year you get ten thousand dollars, or you get one thousand dollars or whatever it is, you get it every year until you die. Into the medical saving incounts. For anybody who sixty five or older today, if you're sixty three, when you turn sixty five, you'll

only get nine thousand dollars. If you're sixty one, when you turn sixty five, you'll only get eight thousand dollars and so on. So the young people can look at it and say, huh, okay, the gunment's gonna give me a lot less money. So, but I have more time to prepare for that. And part of that preparation is going to be I'm gonna save more money in my medical saving account for when I probably most need it, in my sixties and seventies. So I'm gonna start accumulating

money in my medical saving accounts. I'm going to start saving, and I'm going to keep this private insurance. I'm gonna get policies that will cover me when I'm in my sixties and seventies. So the subsidy, whatever the amount is per senior, we keep, in a sense the promise to the people you know today who are retiring or sixty five and older. But anybody entering the system is going to get less. Now how much less you'd have to do the math. You'd have to figure it out. You'd

have to see how the markets evolved too. I mean, it could be the insurance prices go down quite a bit, and healthcare costs could go down quite a bit now that we're creating a real market for insurance, real consumer now sorry, a real market for insurance and a real market for health care. And now we're creating consumers for health care, real demand, not demand by big entities negotiating,

but by individuals. You'd expect healthcare costs to come down, and you'd expect the whole industry to focus on profitability and making themselves profitable by reducing costs, so prices come down through competition and through innovation. Now, I think you would do the same thing with Medicaid. I think for every poor person, however you categorized it, you would open up a medical saving account and you would say, you know, we will fill it up depending on how poor you are,

up to a certain amount. And again, we are going to phase this program out. This is not permanent. We're going to face this program. Although even if it was permanent, it would be far better than what we do today. And notice what happens now. Now you've got insurance companies competing for their dollars. You've got insurance companies competing for the Medicaid and Medicaid recipients dollars because they're still offering

them through the market products catastrophic primarily products. But now you've got doctors and hospitals competing for their dollars rather than negotiating with the you know this massive Medicare or Medicaid. Now they're negotiating with real customers who are price sensitive. So you know you you I rather you subsidize generally and eliminate all regulations, then regulate and become a direct purchaser,

So it's better. I think I'm gonna just subsidize its in a sense that provides a cash benefit to people. And in this sense, you know, I have some sympathy for the universal basic income. If you could guarantee to me that you would, you will need to get rid of every single welfare and healthcare and education dollars spent by state, local, and federal government, every dollar spent on welfare, but also on healthcare, education, every dollar spent. Then I

think a universal basic income would make a lot of sense. Basically, what this valture system is moving us towards that giving them the money so they can buy it and then start phasing it out. So have a universe of basic camcome let's say, University of basic income, says everybody gets fifteen thousand dollars a year. I'm just making that up, and then every year would go down by a thousand, so that in fifteen years there's nothing and the welfare

state is zero. Doubt or maybe you think that's too quick, and every the year it goes down by five hundred and within thirty years it's zeroed out. It's fine with me by me as well, and the same here. Ultimately, the push should get nothing from government to buy health insurance or to cover their health expenses. And to a

large extent, you know, capitalism would eradicate poverty. That is, the whole goal should be to grow the economy so fast that in absolute terms, nobody is put and for the freak event where somebody really can't afford it, that's what charity is for. And the same thing with old people. People should be incentifized to be responsible to save save money for old age and if they can't or if they don't, if they don't because everybody can, then charity will have to take care of them. But I get

it that you can't advocate for that today. That is long term, that is in fifteen years, when we phased out all these programs are thirty years when we phased it all out. And this of course brings you to Medicaire Obamacare Obamacare. If we phase our medicaid and phase our medicare and we move all insurance to individual insurance, Obamacare goes away. There's no reason to subsidize exchanges. You're ready in a sense, subsidizing the individual to buy the

healthcare there. They're either medicared or and insurance costs. Because the insurance market is deregulated, the insurance costs are going down, and there's just everybody can afford insurance. And those people who are really too poor to affod real insurance, real insurance being catastrophic insurance. Uh, you know, you're basically giving them a subsidy. So today Obamacare subsidizes people who are not in medicaid but who don't have enough money to

buy insurance. But that's because insurance is so expensive today because it covers so much, it's so heavily regulated, and it's not real insurance. It's a risk pool. But if insurance becomes real just catastrophic, and if everybody can have an MSA and they can start saving even if it's a little bit of money for the annual doctor visit, for the getting a flu or getting a something like that.

You take away the need for the additional subsidies on top of Medicaid and Medicaid that Obamacare requires, and now you just have a real marketplace and insurance. But then it becomes real insurance i e. For catastrophic where unpredictable events and the rest you're safer. So again I'm advocated of a UBI to be phased out as a step towards getting rid of the welfare state. So you're not going to get rid of the welfare state without some kind of transition. You're not going to get rid of

the welfare state like that. The best way to phase it all out, you can phase out Medicare, Medicaid, you can phase out. And by the way, one thing you could do with medicaire is the valure system could be means tested, right, the values system can be done in a way that and this reduces cost dramatically. Not everybody gets it, so it's like medicaid, if you need it,

you get it. If you don't need it, if you can afford the manic the the health insurance costs and the and your health expenditures, then you don't get it. So you can come up with a way in which the annual expenditures is already going down dramatically, and yeah, that makes it. You know, it's it's now mean tested. But I paid all my life taxes for medicaire. You just pay taxes. We all just pay taxes. It's not going to any particular thing. It's all fungible. So security

is functible, Medicare is fungible. And indeed most most people spend uh spend four times more, four times more than they ever paid into. So all of these things need to be phased up. The idea that you can get rid of them all in a bang, it's never going to fly. It's not doable. Maybe in a horrific crisis, but then you don't want to you don't want to live through that, so you phase it out. So UBI only as a means to phasing out the welfare state.

All right, I'll just add that part of the massive deregulation would dramatically involve FDA reform and ultimately the prioritization of the FDA. The first step of the reform could be uh, the FDA approves drugs only in the basis of safety, not efficiacy, and then you know a market will evolve for different labs that evaluate efficacy, and then you can basically get rid of the safety issues around

the FD as well and privatize those. It's ultimately you want all drug development approval to be to be private. And here you know, you've got to reform the way drug development is done. We've got to reform the way science has done, the way grants are given. That's a whole other topic we can do another time. But ultimately you want the government out of that as well, out of that as well. But every again, all of these

things involve phasing out over time. You're not going to get a government that is going to just drive everything down to zero. I mean, you want the fdiut of recommending food, you want them out of food inspection, you want them out of the whole gamut of what they do. But in healthcare, what you want is to reform so that you can get more dru on to the market

and then privatize, re fum and privatized. Now, note that if you do all this, wages will go up quite a bit because you know employers who now do not have to buy you health insurance will be able to give you that money as salary. That is money that can immediately go into your medical saving account. So wages go up as a consequence of all this. As government spends less on healthcare because it's phasing out Medicare and

Medicaid and making Medicare means tested. As all of that is being phased out, the government is spending less money and hopefully taxes come down at the same time. At the same time, outcomes improved dramatically. It's more innovation in the system. There's more doctor and generally producer involvement in the system. Hospitals start caring about you. Doctors start caring about you. Not that they don't care now, but they have an incentive to provide great service because you are

the one paying them. Doctors become more engaged in potentially alternative solutions, more interested in finding alternative means to solve problems. They become much more engaged in problem solving than just being bureaucrats. They become engaged, involved and responsible for your

health together with you. So the whole system shifts. It becomes dynamic, interesting, exciting it and again, particularly if we get to shift to where the tear calls three point zero, where the doctor now becomes your consultant on staying healthy. It can become fun, experimental, It becomes something that even as a consumer you embrace and look forward to, versus going to the doctor. Now, when you go it's typically because you're sick. Imagine going to doctor in order to

stay healthy, in order to stay fit. You would see, you know, new drugs on the market, new medical techniques, new medical devices, new procedures, and a general orientation towards health, a general orientation towards staying healthy, rather than the orientation of just you know, solving problems when the problem already exists and when solutions are limited. I think you'd see a lot more medical trials. I think, particularly if we have formed the way medical trials are done, which I

think needs to be done in dramatic fashion. A lot more medical trials, a lot more experimentation. I mean, we are I believe on the costs potentially of just a revolution in not just prevention, which I think again people

like a t leading, but of treatment. You know, whether it's vaccines against cancer, immuno therapeutic, all kinds of immuno therapies where we teach our body or train our body, or induce our body to fight the cancer, which is what the vaccines do, or whether it's massive amounts of new drugs in the pipeline to treat autoimmune diseases, which could be major evolutions, major evolutions. So you know, again we could see life expectancy, but more importantly, the quality

of life dramatically improve now. And I want to say this. I think it's important to say this to finish off. In spite of all the problems that medical system has today, and it has big ones, particularly when you think about the potential and what could be and how long we could live and how well we could live. What is truly amazing. And this is a testament to the heroism and the dedication of doctors and researchers and scientists and

pharmaceutical industry. Why I hate that tax on pharma. What is truly amazing is how much gets done, how much innovation is indeed happening. As I said, the American healthcare system. If you are sick, there's no better system in the world to be under. If you take away the light the stupid lifestyle choices that Americans make and if you just look at outcomes, if you get cancer, which healthcare system would you rather be in? It's not even close.

You'd rather be in the US. If you had heart disease, which healthcare system would you rather be in? Now? So we have an amazing healthcare system, and if we make it, and if we make these changes, we can have a just an unbelievably amazing healthcare system. Health care system. I think there could be better, you know, uh, in extending our lives and more importantly in improving the quality of our lives than anything we can imagine today, anything we

can aagine today. So it's yeah, I think it's super exciting. I think the potential is super exciting. The depressing part is that these things are very unpopular and almost impossible to get through, and there's no energy, there's no passion, there's no real drive to get big time healthcare reform done, particularly not dramatic, dramatic reform like I've articulated here. There's

too much of this idea. It's not become inculcated in people's minds that healthcare is are right, which is the I think the biggest barrier to this, and therefore must be supplied by the government. Healthcare is are right in the sense that you have a right to go out and seek whatever treatment you want, as long as you're willing to pay for it and as long as the providers willing to provide it. All right, Yeah, hopefully that

was useful, helpful, informative. And again there's this idea of a if we could just get medical saving accounts for everybody, that would be a huge leap forward. And there was work done on that, and some of it led by objectivists ten, fifteen, twenty years ago, but it never took off, partially because of massive regulations, and partially because msas were always limited, always constrained, and partially because it's hard to

compete with employers who can just provide this. The employer tax deductability has to be eliminated, it has to be phased up. All right, Thank you guys, So we can go to our super chatter is. We've got a lot of questions here and we've done really well in super chat, primarily because Wes came in with five hundred dollars. Wes,

thank you, thank you, thank you. This is fantastic. We're about fifty eight dollars short of where we need to be to get to our seven to fifty, which is the goal for a three hour show, and it's likely, given the number of questions, that will at least at least enter into the third hour, but we will see. Actually not that many questions, so maybe not. But anyway, we're doing great, So thank you. Let's see what do

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ran dot org slash start here. All right, so let's uh, let's look it out super chat and cover that and see where we go from there. And we will start with Wes. Five hundred dollars really really appreciated. Wes a regular, ongoing super Chat supporter of the Iron Books show and just just steady, regular amazing and then you know, once in a while a big chunk like five hundred dollars

that that is. You know, it really motivates me to do shows like this that not only do we have sponsors for, but we also didn't have somebody like West willing to put a lot of money in for it. It's not going to get a show like this is not going to get the most views. My Immigration to China shows did not get the most views because people like the newsy stuff. They like the the controversial stuff,

and they're not interested in the solutions. Necess certainly they're interested in the in the angst, in the in the controversy, and the bash the bashed the left kind of stuff or bashed Trump kind of stuff. UH. So I appreciate it when I do a show focused on solutions, uh, focused on on potential solutions, that it gets so much support. All right, Wes says, I am a data analyst that has worked with some of the largest healthcare systems in

the country. The whole system is so convoluted. I can say that almost no one knows how hospitals actually make money, including the people who work in the industry. Yes, I mean, I mean basically, hospitals make money by charging more than they spend. But here's the thing. A lot of times hospital will lose money on the Medicaid patients and then make money on their private insurance patients. And in some cases they might lose money on some procedures and make

money on other procedures. And the whole thing is convoluted by the fact that there's no pricing transparency because the customer don't care about prices, so hospitals come up with all these They're acquired by law to have prices for everything, so they basically have prices that are ridiculous. I heard sixteen dollars gauze a gauze patch right now, nobody actually pays sixteen dollars to the gauze, but that's the price that the hospital lists. I guess you pay the sixteen

dollar gaus. If you go in and say i'll pay cash and you don't negotiate with them, then maybe you'll pay the sixteen dollars. But that's because why not have the highest prices possible on your website and then kind of not on your website, but because they don't do it on their website, but has as they on their price sheet, and then they sit down with the insurance companies and they negotiate down from that and a lot

of it. The way it's paid is not paid by item, but paid by procedure, and then before it includes all the things that go into the procedure. So Bye bys surgery, all the all the hard way involved in a bite by surgery is going to be is going to be paid in bulk. There's a price for that, and then the doctor gets paid and the staff gets paid. Do you know how much a doctor gets for bye by surgery?

Something like between a thousand and two thousand dollars. That's how much he's reimbossed by an insurance company for bye By surgery. And you'd think it would be a lot more than that, right, given I want to pay the guy who's doing who's opening me up and playing around inside of me with my heart, I want to pay him a lot of money. I wanted to get a lot of money because I wanted to do a good job. But they do a lot of them, so they make

a lot of money at the end. But and a thousand dollars might a thousand and two thousand dollars might include all the meetings you had before and all their post up meetings you have with them. It's pretty amazing how cheap it really is. So the pricing. So they have a whole thing where they negotiate with insurance companies so when you go into the hospital. So when I was in hospital, I got a bill from the hospital even though I wasn't paying, I didn't care, And it

was like absurd. It was like half a million dollars. I was in the hospital for like five six days, I think six days half a million dollars, and I think the insurance companies maybe paid one hundred and fifty thousand, and given what was done to me. Then, given the service I got and given everything else, that's not a lot of money. I don't think for the five days six days at back surgery. But it was complicated back surgery, and it took hours and hours and hours, and I

don't know how much the doctor got it. I hope he got a lot of money, because he spent the whole day just on me, like it was a nine hour surgery, and then he had to go back in two days later for another four hours.

the same thing with drug prices. Drug prices are listed at these incredible rates, but then the insurance companies get discounts and the pharmacies get discounts and individuals get discounts. And I don't know a lot of drugs I see out there in the market, you know, the ones that are popular and maybe out of patent, unbelievably cheap, a buck of pill, less than a buck of pill. Sometimes you just get them free. The insurance is covering all

of it. I mean, it's bizarre, and so price becomes it becomes meaningless instead of private individuals actually seeing a price, choosing partially based on price, you know, paying their doctor directly, and the insurance stepping in with only oh, you know, the real massive amounts you had to go to hospital. You didn't expect the one hundred thousand and a million dollar cancer treatment. Stuff like that is where the insurance companies and they they are fine with it because they

priced it is catastrophic they know. And then there's less than out of coverage because it's understood what the insurance is for. So yeah, it's unbelievably convoluted, unbelievably complex because it's trying to do what cannot be done, which is, you know, have a third party allocator fund all these things that it shouldn't be funding. You're trying to fit into an insurance model something that's clearly not insurance, and that just makes no sense and it provides all the

wrong incentives to individuals. Thank yous, all right, Andrew fifty dollars. Any honest economist knows that free market's lower prices and increase quality. Yet mainstream intellectuals, according Rand, practically catatonic when it comes to capitalism. Health Care is too important to be left of markets, They say, what say you, well, I mean health care is too important not to be left of markets. The same with the education, the same

with everything. You know, help government is force, government is coursion, and a gun cursion and a gun have no room in the doctor's office. They have no place in the operating room. They have no place in drug development. So what you want a market's? Now, well, markets always lower costs, I mean yeah, for equal quality, but quality might go

up and cost might increase. And the point about health care being expensive is for whom like I get it that Medicare Medicaid are unsustainable, and they are unsustainable, But you know, is healthcare is how much of your budget as an individual would you be willing to spend on healthcare? You know, a lot. What percentage of your lifetime income are you willing to spend to be healthy? I don't know.

Some people spend, and I don't think this is outrageous twenty five percent of their income to stay healthy and to treat diseases when they crop up? Is that unreasonable? Other people spend a fraction of that. But what's the right number? Well, only the individual can decide what the right number to spend on healthcare. Healthcare is not expensive. Seventeen point six percent of GDP? Is that a lot? I don't know.

wrong andymol inefficient. So what I want is a system that gets rid of redistribution, gets rid of the cross subsidization. Now again, you can't do that all once, so you're gonna have to subsidize over time in order to get rid of the subsidies ultimately. But the worst kind of subsidies, and this is I think an important point, generally, the worst kind of subsidies are the hidden subsidies explicit out

there here. It is, you know, Eavy Electric, call you by the gouvernment gives you a two thousand and our check. All right, we get that, we might not like it, but we get it. But when the subsidies involved, well, we're going to actually subsidize the battery and we're going to subsidize the development of whatever. If you look at EV subsidies, for example, of the subsidies are hidden, you never see them. What you see is just the tax advantage that the gunment gives you to buy an EV.

But that's not the main subsidy. The main subsidies all kind of little things that are inside those are the ones that do the real damage, because those we don't even know exist. So get rid of those, and then then we can phase out the known subsidies. So many can't medicate huge subsidies, huge subsidies, super inefficient subsidies, super distortive subsidies because they start the whole market for healthcare by voucherrousing them. You still subsidize, but now the subsidy

is explicit. Everybody knows how much it costs per person, and those vultures are used in a private economy in a lesser stortive way. Now, the supply side of healthcare response to demand directly, not through some government entity or through some kind of employer provided a third party payer, but directly. And again then you have a means also to phase it out. You have a means to get rid of it. That is, you just reduce the subsidy every year, you make it smaller. All right, thank you, Andrew.

All right, John, are you familiar with former Rand fan John Goodman, whose policy ensued promote healthcare form. Yes, I think it's in Dallas. I know John, We've talked periodically over years. He's quite good on certain things, you know. He Unfortunately he's abandoned Ie Randa a long time ago, and is a little too forgiving of government intervention in the economy, government intervention in healthcare too moderate when it comes to that. Some of you consider me too moderate

in my reform proposals. But he's even moderate, more moderate to me, but on the other hand has a deep understanding of the field, often has interesting solutions to particular problems. And it is one of the people working towards making healthcare free. And I give him credit for that. And we need a lot more think tanks institutes that are dedicated to things like that. There were a number of good free market healthcare institute. The one run by objectivists

is AFCAM. I mispronounced its name last time. It was Americans for Freedom of in Medicine. I think American's Freedom of Choice in medicine. Somebody correct me on the chat if I'm wrong. They're an objectives to run organization. Amy Schidlog is part of it. We've got one of our scholars at the Inran Institute is running it these days. Ray and Ray sure and yeah, I mean it's going to be exciting as Ray ramps up what they do to see how they start trying to influence the healthcare system.

We will have somebody from AFGHAM on the show later this month. They will be sponsoring a show to talk about their approach to privatizing healthcare, to fixing healthcare in the United States. So you'll get a perspective of doctors and physicians and people in the field, rather than my perspective, which is as a economist inspired by a philosophy Jason.

Europe would have us believe you have the public mandate insurance eight percent of income, but you can go to a private doctor and pay out of pocket and it is still far more affordable than the United States, granted not the male clinic. So I don't think that's true. It's probably true of a lot of day to day stuff. I don't think it's true when it comes to big items heart disease, cancer, autoimmune diseases, Alzheimer's. I just don't think that's true. But look what Europe does. What Europe

does is Europe basically places restrict supply. It places constraints and supply, and therefore that is a that is a way for them. Then they do that with price controls. That is a way for them to they so they ration Europe and socialized medicine JET generally is a rationing mechanism and that's how they keep prices under control. And so it's cheap in the system because it's it's a rational system. Because a suppliers will only provide so much at those prices, so I guess you can go to

a doctor and get stuff on top of that. I haven't run the numbers. I don't know what it would cost uh, and it could be. I mean, our employer based insurance system is very, very, very expensive postively for the reasons Wes said. It's so convoluted that nobody knows what anything costs, and there's a huge amount of waste, and there's a massive amount of bureaucracy, and the reality is that there is a sense in which like the NHS has less bureaucracy than the American elcare system because

it's so convoluted. Single payer is simpler. You want an MRI, fine, you don't stand in the queue. But it's simpler in the sense that we don't have negotiate prices. We don't have to monitor which MA you got. You know, you just stand in que and you get the MRI. Like everybody else is m A. You don't have any choices. So if you reduce choice, you can reduce cost. Now, the private sector in these systems is typically very small, particularly in the UK, and you can't get the major

procedures there. You can't get major surgery and get the treatment under the major major stuff. Socialized medicine eliminates choice. So the one thing it eliminates, I mean, and it constraints supply, so it rations. So the choice you have is rationed. Alexis says on the chat seven hour wait in er emergency room in Central London Hospital for an

allergic reaction. Now you can get long waits in the US as well, but that's because we have regulations, for example, that four stocked hospitals emergency rooms to treat anybody who walks into an emergency room, anybody, whether they have insurance, they don't, where they can pay, where they can't, whether they have a heart attack, or whether they have the flu, And that creates bottlenecks, and then that turns it into

a European like emergency room. But if you basically said, yeah, we're not treating flu patients, We'll only treat who we want to treat. It's an emergency room, then you would have a very different emergency room experience. All right, thank you, Jason, Jennifer. My dad and yours were doctors. People have no idea how hard they work to get there. It makes me so sad, so mad when people think they know medicine when they never study to practicity. Yeah, I mean you

see it all the time. We've got we've got amateur doctors everywhere, experts in the field of I mean, you know, vaccines, immunization, you know, diet everything, and heart disease and cancer, and they know exactly the causes and the cures and everything. It's ridiculous. But it's not just how hard they work to get this, it's how hard they work as doctors.

At least now, my father worked mostly under a socialized medicine system in Israel, but he had to make a living because he got paid by the government, and the government paid doctors very little, so he then had to have a private practice on the side, so that was in the evenings. And you know, see, he worked all day, taught at the medical school, ran a department at the hospital, and then in the evening he had a private practice. So we never saw him skids. He just worked to work.

A quote Bobara illustration had a new replacement last year in Europe using private paid. Total cost including five days in hospital, was ten thousand Europe. In the US, the cost is one hundred thousand Euromon and patients are sent home the day of surgery. Yeah, absolutely, I mean I had. I had back surgery in the in the US right outpatient. I was sent home within hours, which I like. I don't want to spend the time in hospital. I don't like to spending time in hospital. You shouldn't have to

be five days in hospital for a knee replacement. And I didn't pay anything. I didn't pay anything. I don't know how much it cost the insurance company. I have no idea. It wasn't one hundred thousand because it was outpatient. It was probably ten thousand. But I got out of there. And the only reason it cost me And this is the beauty of the American system, and maybe you can and I think you can do this in parts of Europe.

Not every way, though, is I convinced my doctor to inject me with STAY, to inject the disc that he was cleaning up with stem cells, and for that I had to pay in cash. So I think that was five thousand dollars that I paid cash. He basically had to get a machine and to spind the stem cells.

He has to go into my hip and extract bone marrow and then spin it and then inject mice themselves back in and so the whole thing cost me out of pocket five thousand because I paid nothing for the rest of the surgery that was all covered by the so called the insurance that I had. I've spent time in hospital when I got my fusion. I had back fusion that was before that, more than ten years ago, and there I spent six days in hospital, two surgeries, one of them dayly full day, A whole day. New

replacement is not and again it costs me nothing. Now I don't know how much it cost my showings company. That's part of the problem. So it could be that in Europe, if you use the private system, it's ultimately cheaper. I don't know. I mean, you know, I have healthy shows. In the US, it covers a lot. All my surgeries are paid for with private doctors in private setting that I choose my back surge US, with doctors I chose

when I spent in hospital. When I didn't, I just had showed the surgery he and Puerto Rico the same day in and out of the hospital. I chose the doctor. I could have gone to the US. I could have chosen any doctor in the US to do the same surgery. I didn't want to because I wanted to be you know, if there was complications or anything that I wanted to be close to the doctor. Didn't want to have to

fly to see the doctor. But the I could have chosen any doctor in the United States to do the procedure. It would have cost me the same here as it would have if I'd gone to the male clinic to have it done. Zero. So I am You know, you could argue I'm super happy with kind of the direct costs and the healthcare that I get because I get to choose my doctors. What I'm not happy about is what I know is possible in a proper privatized HEALTHCA system.

What's missing is the innovation, the dynamism. And I pay a lot of a lot of money for insurance. I personally, it's not through a business. And I pay a lot of money for insurance because again I'm subsidizing Medicare, I'm subsidizing the the the I'm probably subsidizing the employer based system.

I'm not getting a tax deduction on it. So you know, there's a there's a huge subsidization cross upsietization going on here from me to other people that I'm not happy about, and again I'm not happy about the fact that it could be so much better. But I get I believe that today I get the best healthcare in the world, and for me, in terms of my expenses on healthcare, probably about as cheap as it gets. I mean, I yeah, I mean I wish it was different because I think

I can imagine what else could be. But I wouldn't want to be in Europe. And I appreciate what you're saying, Baba, and but yeah, and you know, I think that if you can get, if you can, if you can be in a private healthcare system in I think, like the Swiss system is really good, and there may be other systems that are really good. I would never want to be in the UK, even with private healthcare. I wouldn't

even with the potential for private insurance. I wouldn't want to be in a lot of these social life medicine countries. I think Switzerland is unique because it has a private sector adjacent to it. It's also relatively less regulated. You can do a lot of procedures in Switzerland you can't get here in the US. There's a lot of stuff you can do with stem cells in Switzerland but also in South America that you can't do in the US. So imagine if we got rid of all those regulations

and all those controls yield twenty five. Can you recommend any good articles of books that discuss healthcare in the way you just did or smaller? God, I don't know. I mean John Goodman. I think look John Goodman for books on healthcare. I can't remember now, I've read some in the past. There were some good books on medical saving accounts, but no, I don't have off the cuff books. But look for books on medical saving accounts, privatizing healthcare.

There are some good books by Cato people, by John Goodman's institute. There's an student in San Francisco, I forget the woman's name, that's written some good books on this. So there is material out there. Alexis what is the common thread between finance and healthcare that made them prime

targets for the intellectual status. Assuming you expect that prem accept that premise, fear asymmetric information, you always get that you know you'll be taking advantage of by the financier if they don't have to register at their SEC and they don't have to jump through all these hoops. We need to license these people because otherwise they'll you out of your money, they'll commit fraud. We need to make

sure they're good people. So asymmetric information in both, you've got experts to know a lot more than you do. I mean, that's true of everything in life. That's the beauty of a society of division of labor and specialization. But finance and medicine, I think are particularly so. And everybody appreciates that. Wow, yes, specialized knowledge is really needed there. That's one, you know. Regulation of them evolved completely differently.

Finance was regulated from the beginning of time because it was viewed as exploitative for the beginning of time because of the attitude was usually the fear of great financial power, the fear of wealth associated with finance. That doesn't exist in healthcare. So other than the asymmetric information and if you that were too stupid to take care of ourselves, which involves both the fear that greed i e. Profit motive will cause real harm exists in both. Other than

I think they're quite different. Healthcare evolved in a particular way, and nobody thinks you have a right to a saving account. But you have a right to healthcare, and that makes it even more difficult to separate, to separate healthcare from government than it is financing government. You're right, they're both emostly charged, but they're mostly charged because on the healthcare side it's viewed as a need, and on the finance side, it's fear of being exploited. I think it's mostly charged

for different reasons. Suddenly altruism dominates the healthcare I'm not just as dominant in the finance. It's there, but it's not as dominant, all right, Andrew, Republicans don't have them all based from which to be serious about challenging how healthcare works in any fundamental way. Ultimately, they agree with mass collectivization of health care. Yes, and you saw that by the inability to repeal Obamacare, by the inability to

repeal Medicare and Medicaid. I mean, go back to nineteen sixty four, the election of nineteen sixty four, and the speeches that Ronald Reagan gave in nineteen sixty four against Medicare Medicare. They're brilliant, they're really good, really really good speeches. He makes a lot of good arguments, but once it was passed. Nobody stood up against it. No Republican ever talked about downsizing it, never mind reforming it, never mind

eliminating it. All they've done is expanded expansion of medicares. Happened out the Republicans by Melianda George Bush two thousand and two three something like that. So, yeah, there's nothing. They never undo any socialist program that's already put in place because they basically they basically accept them all premise under which it exists. Andrew, people have no idea how good healthcare would be under capitalism. It really is the

unknown ideal. Thanks for making it a little bit more known. Yeah, it really is an unknown idea in the sense that you can't imagine the technologies, the drugs, the knowledge, the help, the suggestions, the yeah that would be available under free market healthcare system working to allow us to live longer and healthier. While we're at it, I mean, the experimentation, the innovation, just how to believe, how to imagine, not how to believe very believable, just how to imagine what

it cook says, solving us healthcare is easy. You just gotta outload the profit motive. Then plenty of medicines and healthcare will magically appear for everyone. That's it. It's the profit motive. It's exact opposite. I mean what Cook is saying, it's exact opposite. What we need to do is reinvigorate the profit motive, refocus the now, refocus, we establish the focus motive, the profit motive of every aspect of healthcare. We need to expand the profit motive to touch every

every little bit of healthcare. Rix says, should HIPPA be scrapped and let patients choose how their information is used? So much or a petition of data for every doctor and visit. Yes, if HIPPA were scrapped, I think you'd get a lot more innovation in digital analysis, digital of storing, digital integration of healthcare information. And yeah, HIPPA makes no sense.

I mean, you want a law that says the patient should be able to decide what is done with its information unless, yeah, the patient should decide, including not caring and giving it all to you. And that's it. That's all you want is a law that says the information belongs to the patient. Other than that, you need nothing else. HIPPA is just another creation, another huge bureaucracy that slows down a progress raphel in a country with NHS. How would you go from NHS to MSA's in a free

market healthcare system? I mean it would be a lot more difficult. It's a lot more trenched. How would you do it? You would basically have to phase it out again. You would have to create some kind of means testing, So you would start with I think you would start with Okay, if you make more than one hundred thousand pounds a year, the NHS is not for you, and that's gonna start a year for now. You can't start immediately.

That's gonna start a year for now. That creates in the center now for hospitals to be built, clinics to open, doctors and insurance companies to come about. You do also have to, I mean, immigration policy is really important. You have to be able to adjust the supply of doctors to the new demand. But yet now anybody making over one hundred thousand pounds gets no NHS zero, and maybe it has to be more than a year because you

have to build hospitals. These are kind of factors that have to be put in because I don't know how many private hospitals they are, how many private clinics. Maybe it has to be two years. Maybe you start with five hundred thousand pounds stoling and then you slowly decrease it to one hundred and then to zero ultimately, so you phase it out. You say, who are the people who can who really, really really depend today on NHS. It's the poor, it's people making who couldn't afford insurance

even if it was available. And of course by doing that, you make it possible to cut taxes and to free up people's resources so they can spend it on healthcare, which is really really important. Barbara, I'm glad you brought up the universal Basic income. I'm okay with that as well, at least as a temporary program. I think the money saved and administrative costs would more than fund a reasonable a MT. I don't know, I'm not sure what that says anyway, I yeah, I mean I would only support

it again if it did the following. Every single other welfare and redistributive program has to be eliminated, including Medicare, Medicaid and education, right, and then you introduce it, so all of that would have to be eliminated. And that's a lot. And then I would say it has to be phased in, phase out, Sorry, phased out. It can't stay at the high level. The whole point is the incentivized markets to develop and then slowly get the government out of it and at the same time cut taxes.

So yeah, universal based income. Oh right. Boba says, no means testing, higher administrative costs would eat up the savings. Means testing does not have to involve high administrative costs if you make it very very simple and very very easy. But yes, for the UBI, there should be no means testing. If it's ten thousand dollars or fifteen thousand dollars, everybody,

everybody just gets a check. And you could roughly means tested by saying, okay, if you make if you have, if you make over a turn of fifty thousand dollars, you don't get the check. I don't you know. I think something like that some some very high number. And then and then U bureaucracy creed is not high, and you reduce the cost for the government to do it as atery economy, Hey you're on. If health insurance is they coupled from the employment, would there be a phase

where employers are required to fund individual hsas or up wages. No, but that would happen. Employees would have no choice. Just competition would drive that very very quickly, and employees would know that, so they would do it immediately. You could theoretically, you know, force that. I don't like force. I don't like requiring things like that, but you could force the employer to provide that as an increase in wages or as an initial funding of HSA. But ideally you just

let the market develop in that direction. But yeah, one way to kind of get it spur it is to say, okay, for the first year that we've eliminated employer based the employee has to take whatever they paid the previous year and put it into a medical saving account for the or health saving account that basicam using them interchangeably put them into one of these accounts for the employee, and that way we guarantee that everybody gets an account and

has some money there to begin with, and then starts thinking about buying insurance through that and spending healthcare money through that. And that's a way to transition, I guess you could. You could do that. You could do that as part of the transition, but ultimately you wouldn't want to force that, Bob. But when in the US, I use private clinics when possible, in pay cash. My other pocket cost is almost always less than copey. With insurance,

my copey is almost zero. So I don't know why why you know for you, insurance is so expensive noway, I pay very high premius with the insurance, but then my cope is a very low twenty bucks. I never pay more than twenty bucks. Can't remember when I paid more than twenty bucks. Twenty two, sorry, twenty two is what I pay for my shoulder guy every time I go see him. My cope is twenty two bucks. If I paid cash, my guess is he would charge one

hundred dollars as a Turke dichotomy. I love these informative shows the most. Thank you, Thanks. I appreciate that. I'm glad you like it. Phil says the way, I'm not sure what that refers to. Alejandro says, I moved from my third world country to the US. The only area where my quality of life is declined is healthcare. That's

interesting because I don't feel that way. I feel like I get phenomenal healthcare in the United States, So I just think you have to navigate the system and figure it out, and then once you figure it out, you can get amazing healthcare here, not as good as it could be, a bit amazing. All right, guys, thank you, thanks to all the super chatters, particularly Wes and Andrew did it a lot as well, So thank you Andrew, but thank you Wes. Thanks to Wes, we made I'll

tugget so I appreciate that. I will be back tomorrow's showing Hebrew for those of you who understand Hebrew at eleven am East Coast time. So my show in Israel, and the next US English show is going to be is going to be on Monday.

that UBI out. That's how you get rid of the welfare state. I think that's us how you get rid of government involvement in healthcare and government involvement in education. Now, if you just want to treat them independently as you can deal with them through medical saving accounts and education Saving accounts, which are kind of UBI like in the sense that the government gives you a cash payment, but UBI is an opportunitiosity to get rid of all the

welfare on top of all of that. All right, everybody, I will see you all on Monday. Thank you have a great weekend. And yeah, let's hope we get a little bit of what I'm suggesting. Any one of these reforms would be amazing.