Name: Why Healthcare Costs Are So High in America
Uploaded: 2023-03-28T17:48:07.000Z
Description: Watch the stand-up comedy video 'Why Healthcare Costs Are So High in America' from PowerfulJRE on Comedy Buff. Published 2023-03-28. Transcript available.

Watch the stand-up comedy video 'Why Healthcare Costs Are So High in America' from PowerfulJRE on Comedy Buff. Published 2023-03-28. Transcript available.

The Joe Rogan experience and then healthcare like
Did you see did you see the thing I posted a couple weeks ago about this bill
We got from when my Jill was with the our middle son in San Diego visiting a
friend and he was sick
So she had to take him to an ER right like we don't our doctors not there,
right? Obviously we live here
So they did like regular chemistry lab on him
That's like about a $12 blood test and gave him like I don't know 250 to 500 CC
of IV fluid
That was it
That was it. What do you think the bill was?
$1,200 I
Don't remember it cuz I'd have to look at the post I put up. I think the bill
was 6,000 of which we owed 2,000
That's insane. That's it. That's problematic. That's a real problem. Yeah, it
might have been more than that
$6,000 bill our insurance somehow picked up maybe 3,500 we were stuck with 2,500
now juxtapose that with the following fact
Fewer than 50% of Americans today if given 24 hours can produce $2,500 in cash
Jesus Christ, so when we say health care is the leading cause of personal
bankruptcy
It's the 1st 2nd 3rd 4th 5th like there's nothing else matters besides health
care when it comes to personal bankruptcy
I mean this this does infuriate me to no end like I sometimes think like is
there any other problem?
I would ever be interested to devoting my full attention to besides the problem
I work on now
That's the only other problem that would tempt me in you know
It's interesting too if that problem was really tackled
By by our government and they did it in an efficient way
One of the ways they would have to do it one of the ways it would have to
address it in order to be efficient
Would be to encourage people to become metabolically healthy
Of course we have zero encouragement zero in fact there's is actually the
opposite there's there's encouragement for people to have body positivity and
To not be fat phobic and to not fat shame
you know and if and
there's zero discussion about healthy diets and vitamin supplementation and the
benefits of that if we if
If they just did like imagine if the government was responsible for our health
care
And they realize hey guys guys guys are like we got a real problem here. We're
spending too much money and we're losing money because
What if they're the amount of money that they made was dependent upon?
The percentage of money that was spent on health care
Like imagine if politicians if their salary
Depended on the like see but I fear that that would still get screwed up
because then they would just cut cost right like I feel like
What if that wasn't an option though?
What if we have to we have to cut cost this is the problem, right? We're
spending
We're probably up to ten thousand dollars per capita
Which is I mean we're actually probably more than that. We're probably twelve
thousand dollars fourteen thousand dollars per capita
So we're at two to five X every other developed nation and what we spend on
health care
But why and we get worse outcomes, okay, so the big reason comes down to made-up
numbers
Look at my ER example
The the blood test cost the actual cost of ordering that blood test is twelve
dollars the bag of IV fluid is probably thirty eight dollars
So why do they inflate the cost so much it's because they play a shell game
with the insurance company?
So they say we negotiate different rates with different insurance companies and
we're gonna
We're gonna build up the price enormously, but we're gonna offer you a really
big discount
And we're gonna make you our preferred network you were gonna be your preferred
network and there's a you know a quid pro quo here
Which is the price is enormous, but you don't actually have to pay that much we're
gonna discount it to you
But if somebody comes in out of network, which we were right we were out of
network because you know
We're probably our network is optimized around being in Austin and not in San
Diego
You're gonna get screwed and of course if you don't have insurance forget about
it. You're paying the fake money price
Especially if there's a real injury. Oh, yeah, the real injury you need surgery
and you're not insured
Oh my god
the other thing is we don't have the same laws around
Like drug pricing, right? So so drug, you know the the United States basically
Subsidizes the rest of the world in drug pricing so we in exchange for getting
first dibs on the best drugs
We pay a higher price for them and other countries are basically not going to
pay that because you also have better purchasing power
so if you look at Canada, for example, like the government is buying the drugs
not
The not that not that not the payer, right? So it's a it's a it's a totally
different system and
the challenge is
No system is going to be perfect. But what really bothers me about the
discussion is
We're missing the point that there are three variables that need to be
optimized around and everybody just talks about their favorite one
But you can't talk about one without talking about the other two because if you
pull on one lever
You got to let up on one of the other levers. So the three levers are
Cost
How much does it cost to deliver this care? The second is quality. How good is
the care?
And the third one is access how many people fall through the cracks?
So if you look at the United States, we're very good on quality when we deliver
care, it's the best
There's a reason people come from all over the world here when they need their
cancer surgery, right?
We are certainly at or in the you know at or above the best for everything that
would be done in medicine on
Cost we are absolutely the worst
There's literally no country that pays more than we do for a given service
Wow and on access we're horrible for a developed nation
Horrible right the number cost like what is the difference between like say
United States in Canada? Yeah
Two and a half X I would bet
Maybe three X Wow
Yeah, it's so crazy
And that's not like a third world country or something like that
Right
That's what's so so Canada is killing us in cost they're killing us in access
because
Everybody's covered yes, we have better quality. So you have to so that's that's
the trade-off like right
I mean, I do talk about how my mom is getting largely veterinary medicine in
Canada
I mean like their health care is horrible as far as I'm concerned
Yeah, totally unacceptable many friends in Canada that have complained. No, it's
totally unacceptable there. So they have bad care
But at least everybody gets it and it doesn't cost you any money
And it's is it bad care because the physicians are not incentivized to provide
better care because they don't make as much money
No, no, no, no
So first of all, I mean at least I don't know if I don't want to speak out of
school because I'm so far removed from it
But when I was growing up, they had introduced salary caps. So physicians
salaries were capped
So when you hit your cap you retire you stopped working for the year
So high-earning surgeons like would retire not retire would stop working but in
August because they'd hit their set
Like let's say the salary cap was $300,000 if you earned $300,000 by August you
weren't going to get paid anymore
So though they would just sit down and sit out the rest of the year
Yep, and come back in January it would create this real problem where there was
a bottleneck shortage of docs
Yeah, yeah, but the bigger issue is just that the
Government is in charge of what gets done and what does not get done and there's
sort of shortages, right?
So if you like things that you and I take for granted, right if you tweaked
your knee at jiu-jitsu tonight
You could go get an MRI tomorrow
That doesn't happen in Canada
In fact in certain provinces
It's illegal to have private private clinics where you can go pay out of your
own pocket to get an MRI expedited
Oh my god, it's illegal?
Illegal. I think Ontario is one of those provinces by the way
Really?
Yep
So Toronto
In Toronto, I do not believe it is legal to have private medical clinics where
you can pay out of pocket
So this is where when people say oh, we should just be like Canada. I'm like no
We should do something Canada does we should have universal coverage and then
have the option then you have the option to bolt on
Yeah, but would that be sort of like public defenders versus a really good
attorney?
No, I don't think it would be
Because some public defenders just suck
Yes, of course
No, I think one of the things you have to do is provide primary care and
emergency services for free
Because that's where 90% of your care would be delivered
And is the problem that because of these made-up numbers you discussed earlier
that these people in this country at least are
Accustomed to charging these exorbitant fees like six thousand dollars for a
bag of IV
Oh, yeah
Look, I mean I had I had my I get a colonoscopy every three years
So I had my last one last this time a year ago and
You know because I it's funny that one should have been covered
I don't remember the details on it, but because I was over 45 at that point
So it's counted as a screening colonoscopy, but i've historically always had to
pay cash for my colonoscopies because I started doing them when I was 40
and
The cash cost of getting a colonoscopy at like one of the best guys in new york
city who i've always gone to is two thousand dollars
That's the fully loaded cash cost. That means that's covering the facility fee
the anesthesia his fee, etc
The one I got here in austin where I did it through insurance
the fee was six thousand dollars
I got the bill and you know my insurance picked up. Maybe this is the one i'm
Anyway, my point is my cash out of pocket was almost as bad as the cash. I paid
for just a full-up cash one
It had a whole bunch of made-up numbers
I actually called my gastroenterologist the guy who did it and I was like you
got to walk me through this because like I'm
Struggling to understand these costs and he couldn't really explain it
He's like I I mean
I don't know
Like I I don't really understand it. He's like but but you know like everybody
has sort of a different amount
You know, it's like being at like a bizarre where it's like. Oh, I have special
price for you today