American Healthcare vs. Global Systems: A Comparative Analysis

[00:00:00]hello everybody and welcome back to another episode of how did we not know that i'm nat i'm jack and i'm a step on yay hi everyone today we have a very special guest it's my very good friend esteban and he will be presenting on healthcare around the world right that's right yeah talking a little bit about different healthcare systems across the globe and especially something that's like relevant to the united states as well so okay yeah so i guess um we can start at the very beginning for people who don't know sort of what a healthcare system is um so uh just doing some basic research and sort of my own background knowledge uh so healthcare system really is composed of really three things and so first you have providers or medical providers who are actually providing your care the second is really the population of the people who are taking advantage of that care and then three is really insurers or who's paying for uh your health care um so those those three things really make up a comprehensive health care system and um i guess something off the bat that people might be familiar with seeing on health insurance cards um are the abbreviations hmo and ppo um so in the united states we have um those two abbreviations for insurer providers uh but i can just sort of go into the the basics of what those two uh differences mean um so uh if you've ever seen hmo written on your health insurance card it really stands for health maintenance organization um and so they actually uh cover your care by integrating with uh private providers so an example is like kaiser uh an insurance company but you still you pay them the premium and they sort of like give you a set list of doctors that you can see but if you don't see these doctors you have to pay out of pocket for your care um and then the other sort of big insurance type of company in the united states is a preferred provider organization or ppo um so you still get that list of doctors that you can try to see but your flexibility is greater so the list isn't mandatory and the insurance would still cover a portion of it if you do decide to go to a physician that's really not on their list of of doctors so those are really like to the big differences in the insurer types that we have in the united states and what composes our own health care system so it's just a brief introduction okay um with like the ppo versus hmo when you get to decide which type you have is it just based on what your employer chose for you great question yeah and i think it's really based on um what your employer is willing to pay or help pay the premium for so i think it really depends on employer but also i mean if you're self-employed or even unemployed and looking for health insurance um these are two two different types that you might see so what is medicaid under is that gonna be hmo or ppo oh my gosh that's a good question i don't know probably ppo right because yeah so actually these are i think more relevant to um insurance providers so like medicare medicaid is actually something that we can get into a little bit in the future of talking together because that's almost like a completely different model of providing healthcare so these are really like insurance companies provide care right uh and pay for it um sort of the connection between the people and the providers but medicare and medicaid are sort of related directly just to the government so the government is the one actually paying not the insurance company okay so then is this unique to the united states health care system yeah great question so uh we can talk about some models that i've read a lot about in the new book uh that i recently read called the healing of america by t.r reed so he gives a great sort of overview of different healthcare systems across the globe but no this isn't really i guess unique to the united states like there are definitely insurance companies in other countries and we can talk about how they've sort of integrated that into a healthcare system and model for their own countries and how it works oh yeah i mentioned uh the book the healing of america by t.r reed um and if if you look up tr read on youtube i mean he's a great sort of speaker about health care systems across the globe and and really sort of helping you gain a better perspective of what you think is the best choice for america going forward but he started one of his recent videos that i watched with a quote from a president who won election and the quote goes a nation as prosperous and successful as ours must guarantee the health of all of its men and women safeguarding health care for every american is not a sentimental wish it's a matter of justice and you may think that that sounds like a presidential candidate that i mean should should have been in the running really recently but that was actually said by woodward woodrow wilson in 1912 um in his election for president so it's like not common that i mean sorry not uncommon that um americans have sort of been vying for a health care system that covers every single person um in trying to recognize that it's sort of a moral dilemma that everyone deserves access to health care um but there are a series of uh different associations that have sort of hindered that over time in history and one of those um has been really the american medical associate association wanted government sort of separate from health care back then and so it sort of snowballed into what we have now a little bit more of that separation but i guess what he he talks about a lot in his book and some like of my own opinions on it is that um all other rich countries in the world provide health care for all of their people so everyone is covered but they spend half of what we do in the u.s um and so the unanswered question is really why has the richest country in the world never made the commitment to provide health care for everyone i mean i think that's what a lot of voters who um prioritize health care is one of their their main voting issues today in the united states um is worried about and wants to know more about um so i guess i can go over an overview of sort of tr reads models and explanations because it'll help explain a lot about how other rich countries around the globe are dealing with health care systems but i guess to start off is the us is definitely sort of on the top in terms of strengths with uh we're able to provide the best medical education in the world uh we have some of the most innovative scientific research and development of new therapeutics in the world and we have some of the best equipped hospitals but we are spending tons of money on health care um and obviously there needs to be some sort of change going forward for a healthcare system to be able to pay for people who are also left out of our system and so i guess i'll go over four models and if you guys have questions i hope i i'm able to answer them uh but i can also sort of give a little brief history of um where these models come from and sort of the countries that are utilizing these models so really these models focus on uh two main i guess uh categories so really it's who's paying for health care and who's providing health care um and so in one of the first models that that's spoken it's termed the beverage model and william beveridge was a british man uh and i believe that the history here is that uh winston churchill after world war ii actually employed uh lord william beveridge to investigate sort of social services for the united kingdom and uh based on his investigation they decided that it was the government's responsibility to cover everyone in health care so it was decided pretty early on for the united kingdom um and the beverage model uh to summarize it's it's universal healthcare coverage that's financed by the government so they are the ones who are paying for it um and the government owns uh everything that's provided for people so they own um the physicians and uh all the other things that go with providing health care for these people and it's financed by the government through tax payments and other heavy leverages but the british people are very happy with the system so this is actually a model that's used in the uk where it was sort of invented and and sort of kinked out and then also in other countries like spain and new zealand have sort of adopted this more um socialized medicine which actually i think a lot of people stereotype that like all of europe had socialized medicine right but if you're thinking about that stereotypical socialized medicine i think this is definitely found in the uk and they tournament uh the national health service is who provides all of that uh the second oh sorry before you go ahead so under the beverage model how does that affect the wages of um like medical workers like healthcare workers because one of the main arguments i hear against socialized medicine as americans like to put it is that it would decrease the wages for healthcare workers so like what does that look like in the uk yeah great question so like what i know from um just some background reading and talking to friends in the uk so i i lived in the uk for a little bit and got to experience the nhs but but something that they they have struggled is yeah celery does come down for specialized areas of medicine so something like i don't know a neurosurgeon is paid much less in the uk than they would be paid in the united states health care system i know that there's this is an anecdotal story but i know that sort of in history i mean every country struggles with providing family care physicians um and the way that the uk has done this is that they've decided to pay family care practice positions in the uk more so i believe like their workforce is made up of over 60 family care practice physicians who make twice of what a specialty doctor would make and it sort of has i mean with this control by the nhs they've sort of been able to change um what types of physicians people want to be in the uk and practice as but has also sort of covered that shortage for them um so i think when you have a system where the government is running both payments and sort of providers they have so much more control and regulation over um how they want to switch the the dynamic instead of it being very slow and sort of like this free market type of exchange oh also i have like sorry i have a question about just like european healthcare in general because so i know like because of brexit like england is like no longer part of the eu but um as a part of the eu isn't there like their healthcare isn't it also like if you live in the eu and you visit another country that's in the eu isn't your like healthcare covered if you need to go to the hospital in another eu country like do you know how that works yeah no that's a great question i don't actually know the answer to to to that but i mean um i guess you can share a personal experience of just going from like the united states to the uk um not within europe exactly but i essentially just paid a health surcharge fee when i sort of i guess immigrated to the uk for school um and the health search engine fee was not that much money it was 1200 but i was covered in the nhs system so i mean if i had um come down with something very severe like breaking my leg in a bike accident i would never receive a bill for that by the nhs and it was all covered by just that international surcharge fee that i paid for health insurance to be covered for the year that i was there um so i think that's a also something that my friends in the uk sort of are always shocked about when i talk to them about like co-pays uh my friends are like what's a copay i never pay anything for health care so i mean it's it's covered by the government and with that they've had to cut a little bit for costs and things like that so they also do decide um they do have to make some i guess harder decisions later on about who can receive what type of care or what type of care is necessary for someone to receive so um another story that i have from a friend who's in britain um is her wisdom teeth are growing out but because they're not causing her any pain nhs doesn't cover wisdom teeth removal um so until they start to cause her pain the nhs won't step in to pay for that and so there are like various other things that they control and decide to pay for um trv talks about a really funny one um is that the british healthcare system covers the viagra pill uh and viagra is like a very expensive drug in the united states and so everyone's wondering like okay if the nhs is pressed for money why are they covering such uh i mean a drug that seems like a luxury or something that you would pay out of pocket for um and they're very proud that i think um i've read this uh or i've seen it on a video but they're very proud that the inventor of viagra was british so they're sort of that additional pride yeah that's literally so funny yeah so i mean they have control over what they're willing to pay for and who can receive the care uh but it's a little bit always sort of a tug and pull balance there yeah so uh i guess while we're talking about the uk and sort of the beverage model um i i can talk about some statistics so sort of uh health outcomes of what their system provides for their people compared to the us so we can talk about some statistics now um and i'll quickly give an overview of sort of health care spending so in terms of health care spending per person in 2018 the average um british person spends four thousand and seventy dollars versus the average person in the united states is spending ten thousand five hundred and eighty six dollars so we're spending more than double of what um people in the uk do per person uh with our our different systems uh and then if you want to use another metric there's healthcare spending by percent of gdp so total gdp of the country in 2018 in the uk they spend about 9.8 of their total gdp on health care and in the united states that's much much higher at 16.9 percent in 2018 when that was last calculated um also health outcomes for people in these systems uh there are huge differences life expectancy at birth in the uk in 2017 was on average 81.3 uh versus the united states around 78.6 so you have a huge uh difference in life expectancy for people also the infor infant mortality rate per 1000 births which is sort of a measure of how well the system is doing for people there in the uk was 3.9 in 2017 and in the us it was 5.8 so we have a much higher mortality rate in the us as well so you do see that they're spending nearly half of what we spend in healthcare in the united states but also having at least comparable or even greater health outcomes than we are um and just to summarize i mean it's a service you use and you never get a bill but you are paying it through higher income taxes but again if people want to argue and say like oh i don't want to be taxed more um health care spending per person that that statistic sort of brings back back the reality that people in the united states maybe you're not paying more in income taxes but you are paying more out of pocket for drugs and for procedures that aren't covered by health insurance companies or even a different thing that you're covered by like medicare medicaid um and so i think that's uh where the discussion starts with that sort of argument um and yeah so the way that that people pay for it if that's a question uh that you guys have uh so the more money you earn of course the more taxes you pay and the better you contribute to the system um and like i mentioned some some services are paid out of pocket like dental eyes and some prescription drugs um but these lo these costs are still low compared to the us so um i think the statistic was that they still pay 57 percent less than the u.s and sort of these terms of health care um uh in terms of providing this this sort of health care so for dental prescription drugs um and then again most of the general practitioners or family practice physicians are contractors with nhs so they kind of contract with the government and establish contracts with how much they can earn for their services so the government sets that price list of how many patients they see and what they pay these health care physicians and i guess just to end there with the uk there's very strong support for the nhs and the united kingdom and i think all british people are very proud of their system because i think they know that it works better than the us's uh and there's and i mean they really don't know what it's like to just get a bill for healthcare because it's something that they use as a service um provided for everyone must be nice also can you define nhs for everyone oh sorry yeah i'm so sorry that means the national health service so that's uh what what britain has termed yeah their health care system oh okay so that's just like britain's healthcare system is what they just bring yeah the nhs wow i can't imagine like never having a copay and just like you just walk out yeah i was listening to a podcast the other day and it was from i think like npr life kit and they were saying like this is how you negotiate your way out of a medical bill i was like the fact that we need to have like informational and there's like a whole system of how to do it um and all these terrible stories of people who have been slammed with like a hundred thousand dollars in bills for like emergency surgery i was like we shouldn't have to have this discussion anyways this wouldn't be something as part of the life kit from npr that you need to know yeah it's it's really crazy and i think um i mean i'll get into talking about sort of health insurance companies and other european european countries around the world but like they are different from the ones we have in the u.s because here in the u.s like you can still have a health insurance company deny your claim so they can say like oh i'm not going to cover that like you got treated for it but i won't cover it um and elsewhere in other richer countries like there's regulation where insurance companies can never deny a health claim so they have to pay you back even in a certain amount of time or your premiums free the next month or something like that so there's just so much more regulation i think even in health insurance companies in other in other richer countries around the world so i guess that's a great overview of what um the i i guess i'm i'm stereotyping here too but like most of what americans think um healthcare is like in in europe but the truth of matter is um other countries in europe also have um different healthcare models and and the second one that i'm talking about today is called the bismarck model uh yeah no so the second model that uh tree talks about in his book the healing of america um and explains a lot of what other countries do is called the bismarck model um so the bismarck model is uh used by countries like germany france uh japan um and other european countries and so some history on that the bismarck model is actually named after otto van bismark who was sort of one of the first people i think in the 1870s to sort of unified sorry unified all of these uh german-speaking countries i think prussia was one into one country called germany um and he created many sort of um well i guess what i'm trying to say is he created the welfare state and started to send everyone money from the government so sort of this more like prominent role of the government and the people he was one of the first people to think about things like social security workman's compensation and then by the late 1800s i think is when a universal healthcare system through insurance companies was established by ottoman bismarck and so it's termed sort of the bismarck model uh first developed then and still used in germany today um so again going back to organizing how these models differ it's really who's paying for it and who's providing care right so in the bismarck model who's paying for it so the the system is actually financed by insurance companies um with employers and employees um sort of splitting the cost through payroll deductions sort of what might sound very familiar to what we have in the u.s and what many or even a majority of americans have health and insurance and through but in contrast to the us these insurance companies are all non-profit they are regulated and must enroll all citizens regardless of pre-existing health conditions and also in contrast to the us the government will step in when someone is unemployed and pay for someone to have uh insurance through one of these healthcare companies so i mean in the u.s if you're laid off from your job you lose your health insurance because your premium is paid pretty much through through them as well as your own income but in other countries especially germany the government steps in when someone becomes unemployed to cover their care um and then again going back to that second part of the question so who's providing the care in the bizmark model so all the hospitals and practices are actually private practice so they're not run by the government like the national health service in the uk um and really generally germans and other people who use this system really like their health insurance companies uh because insurance companies have to pay doctors within a certain amount of time so i mean i think it's even a few days in germany um where the doctor can build the insurance company and they have to pay them within a like three day period um also on top of that if patients pay out of pocket for care they have to be reimbursed within something like a two-week period or your premium is free the next month so there's a lot of these sort of checks and balances with insurance companies and people using them in bismarck model countries but they also have really strict regulation of insurance companies um so like i mentioned previously they can't deny health claims so they have to cover everything um also you may ask like how do unemployed or self-employed individuals um not lose health insurance or how do they deal with that in countries like this and the government will still step in and pay half of your premium or the whole premium depending on your income level um so even people who are unemployed or self-employed uh still have some of the help from the government but for the most part the government sort of has a lot of insurance companies to finance health care in these countries but it works well because they have great regulation of insurance companies okay question on that is there a cut off on your salary range where they will stop helping you pay so let's say you're making like six figures and then you lost your job like you have this whole family and everything does the government still come in or do you make too much for them to come help you yeah good question i think um based off of what i know i think that premiums are paid on sort of an income level uh sort of gradient so if you do have a higher income level you're going to be paying the highest premium for that insurance company whereas if you make not a lot of money um or you're sort of low income you get more more help from the government and that sort of i guess equitable way of distributing uh what they do for for keeping people insured but i think what's really important is that the government makes sure that everyone in the country is employed um because they have either they don't have the money or they have the money to pay for health insurance wow yeah actually um like i so when i was studying abroad in japan i was required to enroll in health insurance there and as a student i only paid like ten dollars a month i think for health insurance and they are for 70 of my bill so i i never actually like ended up going to the doctors or like hospital there but yeah the monthly cost was so cheap as a student so it was really nice yeah so i guess i mean to keep along the same lines if you guys want to try to visually compare how germany and the uk compared to the us in terms of health statistics and spending um i can give you some of the same statistics and even add a few but health spending per person in germany is still uh kept to 5800 dollars isn't 17 again compared to the us which is over ten thousand dollars per person um and then percent percent of gdp is also a little bit higher than the uk so germany spends about 11.2 there 11.2 percent of their gdp on health care um also compared to the us which is over 16 percent um and then again uh i think going back to what the benefit of this this model is is that the percent of people covered by germany is 100 in the us it's i think still only around 91.2 um that was in 2017 um so even in the united states today i'm sure there's more than 28 million people who are uninsured um or don't have any health insurance but this country is able to provide that care for everyone and then also in comparison i guess there are just better or comparable health outcomes as well um in terms of statistics so they do have a longer life expectancy um than americans and uh a lower um infant mortality rate as well i'm jealous yeah we pay so much money and we're still gonna die first yeah so um you asked about south korea uh and sort of how south korea deals with with health insurance and that leads sort of into the third type the third model that tree discusses and going back to those two questions um who pays for it and who's providing it so the national health insurance model is what it's called it's used by um i mean the main example of the national health insurance model is canada uh but it's also by used by smaller countries in asia like south korea and taiwan but it combines a bit of both the beverage and bismarck model systems where services are provided via private health care providers but payments are processed through a government-run insurance program which is funded via taxes or a premium paid through employers um so you have both like a mix of uh who's paying for it it's a government but who's providing it it's actually private healthcare providers so it's it's mixing a little bit of those two different model types we've we've talked about the beverage model in the uk the bismarck model in germany uh and then the national health insurance model is what we would term for canada or south korea and taiwan oh the national health insurance model okay nhi i was like nhs no insurance doesn't start with an s but i mean even within these countries they've termed it their this is sort of like tr reads umbrella term um and each country has its own term for it so like in canada they actually term their health insurance system as medicare um talking about the national health insurance model in canada um they're able to sort of limit costs by limiting treatments that are paid for and or making patients wait for elective surgeries so you always hear about people in the u.s maybe complaining that people in canada have to wait so long to be seen right um i mean they they have limited the number of surgeons um types of medical scans and specialty care that they that they um are able to use for people in canada to save money so you will end up on a longer waiting list if you need to take care of like a shoulder that's just bothering you because of arthritis but for acute care everyone is treated um but if the medical problem can wait then you kind of also end up waiting in these in the system um and especially in canada but again like i mentioned um it's paid for through a government-run insurance program so sort of like a single-payer system so everyone pays a tax uh i think they call it a premium in canada um where everyone can go to the doctor for free uh but they pay into the system that pays out to all of the privately owned healthcare healthcare providers so that's sort of the system and how it works in canada and how they've sort of tried to limit costs with it but also make it uh work in their own country and then i guess like jumping to canada and the us since we're sort of comparing statistics here they still do have comparable or even greater health outcomes than what's being used in the u.s they also have cheaper drug prices but uh i guess a comparison you can make off the bat between canada and the us is uh it's a single-payer health care system sort of like the proposed medicare for all program in the u.s by candidates like bernie sanders um that you may have heard of and used um and i guess in terms of statistics health care spending five percent of gdp canada spends about 10 of their gdp um in the us is again over 16 to 17 percent of gdp um and in healthcare spending per person the system ends up costing people about forty five hundred dollars per person versus the us which is over ten thousand dollars um and then even out of pocket spending per person is less in canada than it is in the us uh for other things that aren't covered by uh medicare in canada like certain prescription drugs or something like that they still end up paying less out of pocket per person than people in the us um and again i guess talking about health outcomes their basic universal health care coverage still has comparable or better health outcomes compared to us um so life expectancy at birth in canada is almost 83 uh in the us is uh nearing 79 but it's it's not quite there yet um and then even the infor infant mortality per 1000 bursts is about 4.8 in canada in the u.s it's six so i guess just to summarize um what what canada is following is sort of a publicly funded model with private providers but it was really i guess canadians take a lot of pride in this system because it was established to ensure health equity among citizens regardless of people's ability regardless of people's ability to pay and keep and they do this by keeping administrative costs low and sort of making those checks and balances in the system um but i guess you might be asking like how do these countries determine what's covered what pills will be paid for what procedures are allowed um and in canada i mean it's all determined by the health ministry um who makes these larger decisions and i don't know where they're based in canada maybe it's auto uh you know actually otto was the capital isn't it yeah i think it might be in ottawa where the ministry actually meets and decides what's covered every year what new pills that have come onto the market are paid for and which procedures are allowed for um basic universal health care coverage and then i guess in comparison to the us these decisions are made really by individual insurance companies so i mean say uh nat and jaclyn have different uh insurance companies in the us they each can decide like what sort of healthcare procedures are covered um so one of you guys may have one that's covered by your own company but the other won't and so there's no really like centralized system regulating what insurance companies are deciding to cover in the us but i think like what characterizes canada's system uh is really that they're valuing equity so that everyone receives the same care although medicare in canada isn't able to cover everything like dental and other uh healthcare uh costs i think one of the other things that uh hasn't been incorporated into the system is like paying for things like mental health so i think therapy and things like that isn't covered by the medicare system um but you can buy supplemental private insurance through employers which do cover things like dental insurance eyesight and other things like mental health services um so i guess those are some of the problems that a lot of people might talk about with canada yeah actually like um i when i was in ottawa there was like um i was interning at uh the parliament house of commons and like the mp i was interning for he was on the health committee and so that was like we focused so much about uh providing like universal dental care for canadians that was like his really that was his big issue that he was focusing on and so yeah i think they've been really pushing for universal dental care in canada because yeah then uh the supplemental like private insurance i think is really expensive um so yeah that's just like something you might see on the news yeah no definitely oh yeah like i because like you mentioned earlier like the really long wait times um i've also yeah that is a complaint that i've heard like from my canadian friends and then also i think like sometimes the i guess the quality of uh yeah like the quality of health services can sometimes vary like depending on the region of canada you're living in or um i guess like yeah the province um and so i guess some canadians like if they have a severe medical condition that requires like a uh what would you call it like a specialized physician um a lot of canadians like will go to the us actually to get like specialized care just because the quality is i guess a little a little better in their opinion but yeah yeah yeah no i definitely have heard about canadians coming across the border to get health care um for some of those sort of i guess uh different like elective or more advanced procedures um and i guess like something that also limits them in canada is that because canada has sort of decided on health equity as sort of like their big decision defining this model um you can't even through like supplemental private insurance in canada you can't have them pay for a procedure that's covered by medicare in canada so they don't want like someone who has a ton of money being able to purchase private supplemental insurance and then being able to go to a better physician when that procedure is covered under medicare because they want everyone to have the same care that's paid for by the government system so if you have supplemental private insurance in canada it can only pay for procedures that aren't covered by medicare oh that's interesting also with the canadians that come to the states isn't that really expensive for them because they wouldn't have american health insurance right like it doesn't transfer over yeah i mean i'm just assuming that uh they're maybe paying out of pocket for some of the procedures that they that they get but what like what what type of person do we have examples because i'm just thinking of like if you wanted to come over maybe it's something extreme like open heart surgery that's could be upwards of like a hundred grand do you really wanna come to the states and pay a hundred grand i guess if it's life or death yes but like you're uninsured that's all out of pocket yeah i mean i think something that comes to mind and something i've heard of is um i don't know maybe like you you have a lousy shoulder um and it kind of hurts when you're like trying to grab a cup from the top cupboard but uh in canada's system it might take you eight to twelve months to get an appointment to be seen by a specialty care person for that sort of like ailment um and then it might take another four to five months to actually have a procedure done where you can get that shoulder worked on or fixed so like i think something like chronic pain and issues that sort of get like pushed to the end um and something that maybe a canadian might come across the border to seek care for if they have the money okay that makes more sense instead of like open heart surgery yeah i would hope that's uh covered by medicare and care here right yeah i mean but i mean sort of like it's characterized i mean okay i'll start here yeah i mean the model might need some reform in the future um but canadians are still very proud of their healthcare system and i think a lot of canadians i've spoken to and maybe not also is that they're very proud because they know that it provides sort of health care for everyone on an equal level but they also know that it's still better than the us system there's lower costs and higher health outcomes so uh canadians are very proud of that is it just is the pride stemming from that they're better than us like yeah i mean i think so yeah war of 1812 throwback right yeah i guess enough about canada uh and yeah enough about them we don't need that and the national health insurance model but the last sort of model that tree discusses is the out-of-pocket model so i mean it's it's very transparent and mostly available in developing countries um and i think i mean there's only about 50 richer countries across the world that have actually established healthcare systems but really most of the countries in the world have an out-of-pocket model so i mean it's as simple as it sounds only those who have money for healthcare can afford to access and pay for it um so who's paying for it it's out of pocket and who's providing it really a combination of private private care providers so this is something you might see in like a rural african country and i guess really not great health equity there i have a question um do you know the model for specifically like senegal and china because i got health care in senegal and china and i thought first off china was a trip that was like the emergency room um but it was like affordable and i did get the care i needed it just was inefficient and not as clean as the united states but senegal was really good um yeah so i don't know and it was like very affordable like is what model do they have is that out of pocket maybe yeah i think i think like up the top my head um i don't think china has um a system a healthcare system uh that is able to or like has even decided to try to cover everyone in the country so it's more of an out-of-pocket model so i mean if you can provide so maybe the healthcare costs are lower um but you need the money to pay for them because there's no sort of government association or even insurance companies that are super established with providing care for everyone um and then senegal i would uh think the same but i don't know off the top of my head okay yeah i can't imagine like especially china there's so many people there's like 1.3 billion people so i can't imagine like them being able to use like any other model to like cover every citizen that would be yeah right yeah yeah definitely i think people talk a lot about um like the large like brazil india china and russia who are all going to surpass this a lot in population and how they're going to deal with health care systems um but a lot of it right now is sort of up in the air and sort of out of the pocket sort of the out-of-pocket model for most people is that kind of why i guess the united states healthcare compared to other developed countries is lacking could it be due to our population size yeah so you're i mean that's like the ultimate question right like why is america's health care costs so expensive even though we're the richest country in the world and um i mean like why is america have why does america have worse health outcomes in other countries that we've talked about today um and i think the answer to that is that we employ all of these types of models in various ways or different class um i'm sorry i'll go back so like the reason really is that america employs all these types of models in various ways um so i think it's just a regulation of i mean or really like an organization of using so many different models in the u.s that it ends up being very expensive in administrative costs but also there are people who are left or falling into different gaps and trying to organize so many different models for one country um so it's not a one size fit all in the us and i think that's why it's so expensive um so depending really where you fall in american society and trying to get access to healthcare providers you receive different treatment and care and i really think it's this disorganization of our national healthcare system that leads to high spending per capita and also eventually worse health outcomes compared to other developed countries because you have millions of people being left behind without health insurance that um really speak to a lot in those statistics um and i mean even for example like we don't go to the doctor as much as uh people do in other in other richer countries for preventative health care treatments um and even with each visit that we do we pay more um so i guess it might be helpful to expand a bit about how the u.s healthcare system employs all of these models so we can take a look at some of the types of people treated in each sector and i mean maybe even some listeners might be able to identify where they they fit in here so the first model we talked about the beverage model of healthcare so native americans in the u.s veterans and active duty military personnel are covered by the beverage model of health care similar to what you would find by the national health service in britain so you never receive a bill for your treatment you're treated by the government by government hospitals and employees and the government buys the pills uh and they really cover sort of the cost and the providing the the care so um that's sort of maybe the type of people that you might find utilizing the beverage model of healthcare in the us whereas the bismarck model which is what we talked about second in germany provided by health insurance companies so this is really mostly the majority of americans so sort of the working person splitting your insurance premium with your employer if that sounds familiar or if you're self-employed and buying into a health insurance program um these are sort of more similar to the bismarck model of health care similar to france and germany um i think about 150 to 160 million americans received care through this route but again the big difference here is that our insurance companies aren't heavily regulated we even have for-profit insurance companies in the u.s still which sort of blows my mind i mean uh are you putting the money back into providing the best care for people or are you providing dividends for people on a monthly basis so i mean the regulation in america really lacks in terms of health insurance companies compared to countries like france and germany um and then talking about i mean if you're over 65 and you're getting insurance in the us through a government-run program called medicare you're a person experiencing something similar to canada like the national health insurance model and i think more than 40 million americans are on this model in our system sort of the aging population and then uh if you're part of the nearly 30 million uninsured americans in the us right now you're like a person living in a developing country in rural africa or south america because you're using sort of the out of pocket model that we discussed earlier um so i guess what tree talks about a lot in his book and i'm like a huge plug for this book jacqueline said it was boring yeah you don't have to bring that in there [Laughter] i'll say yeah so i mean another big plug for this book the healing of america by t.o reid is that he is able to i mean bring up like what's the main difference between us and other countries around the globe um and he mentions that all other countries have decided to pursue one fundamental model so it's not a mix of all these systems and rules and models and administrative costs like trying to figure out um what sort of who's providing your care and who's going to pay for it so i think like that's the advantage of using a one-size-fits-all healthcare system especially in the u.s um because it becomes simpler and cheaper to manage there's a set of rules and prices that are set by a governing body there's cost and transparency um so if you you go to the doctor and you you want a medical procedure uh done they can tell you how much it's gonna cost because right now i mean if i went to the emergency room um and i don't know needed stitches and asked how much it would cost they would say well i don't know like who do you who's your health insurance provider i don't know how much they're going to cover um they won't be able to tell you versus like having a system where you have that that price schedule and they can tell you exactly how much it's going to cost who they're going to charge who's going to pay for it um and then also i i've mentioned administrative costs so that's sort of a vague term um but i guess to expand on that it's a lot of like the paperwork in the back side of deciding who has health insurance who's charging their health insurance company um and in the us i mean the statistic is that there's about an 18 to 25 percent cost and just administrative costs to every bill that they pay for medical procedures and what other countries have found using one single model is they are able to keep these administrative costs low so i mean canada has a five percent administrative costs britain is five percent um france is three percent and i think taiwan keeps it below two percent of administrative costs versus the us who is spending a lot more money in these terms of in terms of just trying to organize and balance all these different systems yeah it seems like like how i can't even imagine trying to regulate everything in our healthcare system because there's like there's so many different models and it's like i guess uh it just your healthcare and your like health insurance experience depends on where you are in society and like it's so different for each person it's like how can you expect to regulate that if there's like four different models i guess um definitely i think just like one of the i mean what's what's crazy about our healthcare system right now is i mean if you're covered under something like medicare i mean you're receiving the same exact procedure um doctors receive less for the procedure when your provider is medicare because it's being paid out by the government but if you have private health insurance they're able to charge your private health insurance company more so the private health insurance company is paying more for the same procedure than um a government paid out version of medicare interesting wow yeah that's wild can you talk about um like not to get too volatile but yeah can you talk about kind of the pros and cons of obamacare because one of my friends from spain was talking to me and he was talking about healthcare this is before i had any idea about like what the healthcare system is like in america he was complaining about the american healthcare system and he was like obamacare i mean spain had that like way back in the 1800s you guys are so far behind so what was obamacare he was saying it was like a first step towards getting better health care what are the pros and cons yeah why do people complain about it yeah no i think every american has this question and obamacare is always thrown out there you know um and not i mean even i i'm not an expert on obamacare i can just sort of share my own perspective of what obamacare brought to the system for us but i think like the biggest parts of the affordable care act is that it expanded coverage to i believe over 20 million more americans who are uninsured were able to apply for health insurance coverage um because they they across all income levels uh tried to expand um i think it was medicaid um and other health insurance uh i guess private coverages um sorry let me back up because i'm trying to like organize my thoughts there okay yeah that was too wordy um oh you got it you're doing well it's like a lot of good information and i think you're explaining it really well too okay thank you yeah way better than the book oh reading the book was like honestly okay so i'll talk about okay yeah i yeah so i mean um yeah i'm definitely not an expert on the affordable care act or obamacare but i can just share a little bit of my own perspectives on like what it brought um and maybe what your friend was mentioning in europe so i mean off the bat something that comes to mind is um i've mentioned private health care insurance companies in germany and france can't deny you coverage based on pre-existing conditions um so in the u.s before the affordable care act was passed um i mean here's an anecdotal story that was shared in tierra reed's book and something that was like very vivid and i remember so well because it took like i mean i was just like blown away that this existed in the us but before the affordable care act so there was um this woman who was working uh she had a great job just outside of um just outside of undergrad like she was i think 23 or 24 um so she wasn't covered by her health by her parents health care insurance she had just gotten a new job so she was getting health insurance for her new job uh but she was off of her parents health insurance so i mean that's another edition of the affordable care act it extended coverage on your parents health insurance until you're 26 but before it used to be much younger um so you dealt with a lot of young people who were uninsured but anyway so she got this new job but then she came down with symptoms of lupus and because lupus took a really heavy toll on her life she lost her job so losing her job she lost her health insurance and in europe like i mentioned in france and germany if this happened to you the government would step in and pay your premium for you so that you still have health insurance for health care but in her case she couldn't be um she didn't have a health insurance um so she was paying everything out of pocket for care um until she was uh or actually so sorry the the story she shared is that she wasn't making anything because she was laid off so she applied for um medicaid for low income uh in the u.s and she was getting some basic coverage through medicaid but she was having to go to particular doctors who could treat lupus which weren't her initial physicians that she was getting through her employer paid insurance so she had to change um her provider which had a huge toll on sort of figuring out her problem and also in her care but once she started feeling better she was getting the right drugs you know through medicaid um she ends up getting a job and then she makes too much to qualify for medicaid so now she's uninsured again so she starts looking for insurance companies in the us and and before the affordable care act um they could deny her coverage based on her pre-existing condition of lupus so she had to say like i have lupus i'm looking to be covered um and the insurance company could say i don't want to take you because you're going to cost money and so they denied her coverage she couldn't find a private healthcare insurance company um and i believe she ended up dying very young uh before her before she turned 30. but i mean like something like this um one of the european models i don't think ever would have happened because there's at least that basic um universal coverage for people to have covered those drug costs but i mean this is a story before the affordable care act so i mean one she couldn't get health insurance through her parents because she was too old uh the affordable care act extended that um but also now you uh if you can pay for private healthcare insurance companies they cannot deny you based on pre-existing conditions the other thing that the affordable care act did was expand medicaid for tons of lower income individuals so i think it may expanded for more than 20 million people who were uninsured um when they applied for the affordable care act and um were able to to have a marketplace for health insurance um covering like purchasing their own coverage i have a question too so i hear a lot of complaints over obamacare on an increase in taxes for people because they feel like they're paying out for obamacare now is that true or is the issue lying in the fact that there's privatized health insurance companies that can control your premium so if they now have to cover more people who have um higher health risks then they increase the premium for everyone else under the insurance yeah that's i mean that's a great question i always like i think a common complaint um i don't know the answer off the top my head um of how directly they're impacted by like increased taxes for the affordable care act uh but i do know like when it expanded coverage i mean more people are being covered under this this program that's being paid out by the government uh but i mean i think the response my own response is just my opinion um is that like i'd rather pay higher taxes now um than have to pay out of pocket later uh when you do need the care so i mean if you have like a system that is covering that might as well pay it all up front because us still ends up paying nearly twice of what other countries are paying per person uh every year but it's in hidden costs that you don't think about like prescription drugs or um co-pays and things like that yeah i agree i think i'm already paying a ridiculous amount for my health care and it's if i were to lose my job and if before the affordable care act and i lost insurance as well and i lost health coverage it's like what was all that money that i was paying before like where did that go yeah yeah that's frustrating yeah i would like man like i think you mentioned it earlier but i think just a lot of americans don't really go to the doctors or go to the hospital um like for preventative measures uh like i only go to the doctors like if it's an emergency and that was the biggest culture shock for me coming to south korea like here it's just so much more affordable so people just go to the hospital like all the time i know a really common thing is people will go to the hospital to get like iv treatment if they're really hungover and like it's like anything so like yeah i would just like my friends would just be like oh yeah i was in the hospital this morning and it's like to me like that's just such a it was just really shocking to see how convenient and how affordable healthcare is yeah no i totally agree my friend in the uk um yeah i know she's shocked when she says like you receive a bill for your emergency room visit like i've never received a bill in my life for health care but i mean she says it does lead to like overuse of the system sometimes where people just show up in um sort of like the comparable to our urgent care with things that i mean could be taken care of at home um but for the most part i mean uh everyone is covered so i mean something like that anecdote i just shared of the woman with lupus like that probably would never have happened in somewhere like the uk um and you know talking about preventative care in the u.s i think that's one of our biggest issues um right now in our health care system is that um it's it sort of like limits access for a lot of people but i mean even people with health insurance companies i mean co-pays that's what they're supposed to do deter you from overusing the system um but you have people who i mean have a an um i mean they have an ear infection and they're like i don't really want to pay the 40 copay i want to go to urgent care right now it'll get better i mean i've seen this i mean even shadowing physicians where a woman who had an ear infection didn't go because she didn't want to pay the 40 copay um it ended up turning into a septic infection which is lethal and had to get like tens of thousands of dollars in care um when she could have just paid the 40 copay gotten some antibiotics um and likely killed the infection before it it uh was infecting her bloodstream so i mean there are cases like this in the us where yeah preventative care really isn't at the forefront of our values or or something like that but i mean since we're comparing all these countries uh it's it's important to mention too i mean like even health insurance companies in germany in in france so germany's like competition between insurance companies is sort of benefits of what they can offer people who join their insurance company so in germany i feel like i think they they offer perks based on your preventative care so if you go to the doctor at least once a year you reserve a certain amount of reward points or something um which are paid out in like uh i don't know maybe some sort of gift card compensation or something like that um but yeah but i mean for the healthcare insurance company it's very low you're paying a i mean you're paying like a 600 premium a month and they're giving out these small incentives but i mean it's all preventative care so they're going to catch they're going to catch something before you end up developing a septic infection and the health insurance company has to pay out thousands of dollars for that versus just getting you those antibiotics when you need them so i mean it keeps costs slow for them as well wait tea on that have you guys seen the tlc show dr pimple popper yes i love that show bruh like i was thinking about it the reason why these people are coming in with um for lack of a better word like these extreme skin problems is because they were probably uninsured or they were scared to go to the doctor to get it figured out when it was a small issue and now it's like huge and yeah but i mean that's how we got dr ripple popper so yeah so i guess like what is the solution to the healthcare issue in the us yeah what's your opinion great question something i'm like always thinking about and um i mean solutions are offered by t read in his book the healing of america as well which a lot of my opinions come from um but i think i mean the main issues in the us right now is we we have lower health outcomes um in comparison to these other richer countries who have other health care systems um and we also are paying twice of what they're paying so it's like how do we reduce costs and how do we extend um health outcomes in our own system when we're one of the richest countries with the best medical providers the best sort of scientific research going on in innovation and therapeutics um and i think i think it just plays back to the beginning where like it's very expensive maintaining so many different systems in the us um where it creates a system that's kind of like a mystery like you don't know how much you're going to pay for a procedure you don't know who's covered by what procedure because it's just very confusing on who's providing the care um and who's paying for it um so i mean i think going forward um it's very important that we have like a set priceless of how much the bill will be so there's like that that standardized cost and transparency transparency aspect um this is something that's been rolled down in countries like france and japan um and i guess uh just the thing about going toward like a single-payer healthcare system in the us which is a lot of what's talked about in politics right now um is that lobbying groups and healthcare companies set priorities right now for a single-payer system so it's maybe something that we won't see very soon um but i think just one system that allows you to create a transparent cost and charge schedule as well as um making the like decision that we want to cover every single person living in the united states one way or one like somewhere somehow is very important um and i think what's very important for me in healthcare is really expanding coverage to everyone at least having a system that's able to provide universal healthcare coverage across the board um and i think one of the the solutions in politics talked about right now is to expand medicare for all you may hear that a lot that's essentially uh having the government cover all adult 65 plus and below 18 but then allowing adults to buy into the program so the government would be essentially paying for your your care but i assume that care would still go on being provided by private physicians and things like that but there would be a more transparent schedule so it would maintain coverage at a lot of participating hospitals but it would also allow for easier access to health care options and i think it's just like a transition to one sort of system or model so it might not reduce costs immediately but i guess we won't know until it's in practice i think that's the hard thing about the us health care reform is that no one knows really what to do just final thoughts i give a lot of my background knowledge and a lot of like my opinions sort of on the book by tree and a lot of what i've watched him uh talk because he travels across the world you know to learn these systems um so if you want to know more highly recommend the book um and highly recommend just looking up on looking him up on youtube you may have you'll hear an overlap of a lot of what i've said today well thank you so much for sharing that was like really really incredible you did a really great job at giving us such a comprehensive overview of literally healthcare around the entire entire world it's like man yeah that was really good thank you so much for sharing because it makes more sense now i always thought like healthcare like oh it's so confusing i don't understand anything but yeah the problem i feel like the healthcare issue in the u.s is really complex but when you break it down into just like the basics it's a lot easier to understand and digest absolutely i think this is a big how did we not know that episode like how did we literally not know and it's one of those things that i don't think like we know growing up as children because we don't worry about it but after i got my first job and then i'm paying for my healthcare and i'm paying for my care now it's just ridiculous and i was complaining to my mom about how expensive health care is she was like what do you think our premium was per month like what did you think our deductible was it's thousands of dollars was like this is why like i tell you if you're sick taking a leave and sleep like you're not going to the doctors yeah no i totally agree it's something that you don't start to think about until you're sort of like making the transition to adulthood and then you're like oh this is slapping me in the face like i didn't know any of this existed or how it works right yeah esteban thank you so much for being our guest we really are happy to have you thank you guys for having me um i hope i was qualified enough to talk a lot about the topics today oh absolutely i'm excited to have been here so thanks for that [Music]