There’s not a whole lot to love about America’s healthcare system. It’s insanely pricey, deeply confusing, and continues to yield worse health outcomes than any other wealthy nation in the world. But was the system we have today inevitable?

I'm here to say without any reservation that america's healthcare system is number one in the world in maternal death rates and infant mortality and deaths from avoidable or treatable illnesses and COVID deaths, chronic health conditions and healthcare spending. So cue the lead Greenwood that I'm proud to be an true story. Once I got kicked out of a bar for putting proud of being an American by Lee Greenwood on the jukebox. 

Like ten times in a row I put in 20 dollars and just kept pressing that. I thought it was funny, but no one else thought it was funny. That could be the name of my autobiography, but no one else thought it was funny. The Michael Burns Story, okay. So as you likely know, my home nation is the only high income country in the world without some form of universal health care. And before you type in the comments Obama, the Affordable Care Act doesn't count now. For most of you, this is, of course, not a newsflash. Anyone who's ever had to go to the emergency room knows that even basic services like x-rays, ivs, even Band-aids anvil and Hellas bottle polite can send you home with a bill running between 100 and thousands of dollars. And that's after insurance. True story. So I had to get IV fluids in urgent care of the night my daughter was born. Obviously it was really hard for me a man to to watch someone give birth, but with insurance I had to pay over 300 dollars for that. 

And I have like the good insurance plan for a lot of us anything besides an annual checkup is so expensive it might seem wiser just to wait it out, which might be a good financial planning because you can't keep racking up healthcare builds if you're dead, so what happened here? How can healthcare in the US be so much more expensive and health outcomes so much worse? Why are we stuck choosing between lifesaving medical treatment and bankruptcy? And is there any way to fix this before the American life expectancy drops to that of a medieval peasant. 
 

Let's find out  on america's Healthcare system, how we got here,  So to understand why it cost you 300 and 80 dollars to get your ear wax removed. Let's look at the history now. Medicine in the West stagnated for centuries after the initial innovations of the ancient Greeks. As late as 1850. American doctors, most of whom lacked formal medical education, had at best approximately the same knowledge. 

As second century Greek physicians. But as the germ theory of disease gained traction, medical science started innovating. Hospitals popped up all over to sequester people stricken with infectious diseases, though they were honestly far better at spreading disease amongst the patients, at least until antiseptic practice is improved in the 19 th century. While doctors typically couldn't cure diseases, preventative medical advancements like vaccines, the ability to combat vitamin deficiencies and babies, and the advent of milk pasteurization cut the death rate for American children. Life expectancy began a meteoric rise around 1930. New drugs started popping up for everything from treating diabetes to curing infections, and medicine entered an era of exponential innovation that continues today. In fact, in 1950, more than 90 percent of the medicine practice today didn't even exist. But as we got way better at a not dying, we also faced a problem, how do we pay for the pleasure? 

Back in 1930. Americans spent 23 dollars per person on healthcare, which is 3.5 percent of GDP. By 2022, that number was over 12500 dollars, more than 17 percent of GDP now adjusted for inflation. Medical costs rose by a factor of 30 over the past 90 years. I don't understand how math works, but this seems bad now. A lot of this was due to new treatments, while some was simply the result of our growing and aging population. But a significant chunk was inflation within the medical industry itself. Indeed, until the outlier year of 2022, when eggs cost their damn weight in gold, rising medical costs had outpaced inflation for four decades. 

This is important as history writer John Steele Gordon explains, whenever one segment of an economy exhibits year after year inflation above the general rate and when there is no constraint on supply, then either a cartel is in operation or there is a lack of price transparency or both, as is the case with American medical care. 

Now to understand why it's fair to call Mount Sinai Hospital a cartel. Let's flashback to 1929. Just as innovation was about to kick off, now hospitals faced a glaring issue. They were super expensive to run, and cost remained pretty stable regardless of how many beds were full. So in 1929, a hospital in Dallas. Texas introduced the Baylor Plan, the first ever hospital insurance. 1500 school teachers each paid six dollars a year in premiums were guaranteed up to 21 days of hospital care. 

This wholesome plan totally worked out. The hospitals could keep the lights on regardless of how many patients they had, and school teacherachs didn't have to grapple with huge cost if they got sick. Many hospitals followed suit, eventually building insurance plans for networks of hospitals like the nascent Blue Cross Blue Shield. But there's a key difference between these hospital insurance plans and the ones we know and hate today. They were directly implemented by the hospitals, which meant that they paid all costs for your stay up to a certain limit. But as new expensive treatments started keeping patients alive, longer insurance companies began providing supplementary plans in the 1950 s as money increasingly stopped going into hospital coffers and started passing through the grubby hands of your middleman insurance agencies dang. 

We're gonna get gnarly unless you think that I'm just waxing poetic here. Know that hospital insurance was hardly perfect for one because they only covered hospital care. They had a lot of people that were scarfing down Jelly-o and Overnight wars while receiving treatments that should have been outpatient. 

Secondly, this coverage didn't deal in indemnification like other forms of insurance, which means that it didn't pay you to deal with your medical issue as you saw fit. It simply paid the hospital bill. Now you don't have to be Milton Friedman. To conclude that is, writer John Steele Gordon notes, with someone else, paying patients quickly became relatively indifferent to the cost of medical care. Now doctors and hospitals were understandably pretty stoked on a system that gave them carte blanche to charge whatever they wanted, and they lobbied hard to stave off regulation. Blue Cross' Hospital insurance and Blue shield's Physicians Insurance took over the market. Thus upstart insurance agencies had to imitate their generous model.

As Gordon explains. Hospitals came to be paid almost always on a cost plus basis, receiving the cost of the services provided plus a percentage to cover the cost of invested capital. Any incentive for hospitals to be efficient and reduced costs vanished now. After World War II, companies wooing prospective employees started offering health insurance. 

And unions fought hard to make them broadly accessible. But there was a problem with employers covering the cost of insurance. There wasn't much incentive for employees to pick the most cost-effective plans. Another problem was that insurance company Cherry picked which businesses they'd offer insurance, prioritizing larger companies with healthy workfors now, this drove up cost for everyone else. Then, in the 60 s, the government rolled out Medicaid for Poor Folks and Medicare for Elderly ones, which were structured similarly to private insurance. 

Just that Uncle Sam footed the bill. Usa. This was a bonanza for healthcare providers. 

As whole new swats of the population were able to afford their inflated cost and medical professional salaries nearly doubled over the decade. Now, in the years since, medical innovation is cut down dramatically on hospital stay, but the same new technology makes hospitals more expensive than ever to run yet. Because of the enduring cost plus system, hospitals don't have to compete to attract patients by having the best price or by specializing. Instead, they rely on doctor referrals, which means having the most experienced i. E. Priceciest doctors, the fanciest equipment, and enough empty beds to ensure immediate admission. I'll just remember that it's the opposite of what these say. I'd really be more comfortable if you rewrote the form. No, I'll remember opposite, opposite, opposite. As Gordon concludes. The inevitable result, of course, is that hospital costs have skyrocket. 
At the same time, doctors have since the passing of the Social Security Act of 1965 been paid according to a standard of usual reasonable and customary charges. Gordon explains that doctors could bill whatever they wanted to as long as other doctors were charging roughly the same. The incentive to detect a few dollars out of the fee became strong. The incentive to take a few dollars off in order to increase market share ceased to exist. Basically, if everybody collectively charged inflated prices, the inflated price became the new normal and there was really no reason not to do just that. Meanwhile, the ballooning costs of medical malpractice suits were also getting passed back onto patients and insurers, prices just kept going up. 

Yes, that's correct. Timothy Faust, author of Health Justice Now, summarizes healthcare costs are high because healthcare prices are totally made up. He cites the example of Maris, which despite being the same cost to provide anywhere, very widely impriced depending on factors like I don'tno which doctor is nearest to the machine. He concludes that there is no relationship between the cost to provide care and the prices charged for them. 
Across and even within hospital facilities, the whole thing is totally made up guys. The thing that ruins people's lives is just made up now for many people. America's. 

Healthcare system isn't really a day-to-day concern since the Affordable Care Act added 20 million Americans to the ranks of the insured. 
Health insurance basically works for people who are healthy, insurance costs are reasonable and wellness checks recovered. But let's say I don't know you're sick or disabled. They're struggling with mental illness if you actually need healthcare beyond an annual checkup.

Well, hey, it's a different story and not a good one. Because according to a 2017 study published in Pained Physician, the ACA functionally ensures we all have the right to affordable health insurance, but not necessarily to affordable health care. Crucial difference, insurance doesn't do a lot of good if you can't actually use it.

The study found that in the years since the ACA was implemented, actual access to health services has diminished, particularly for low-income folks and Black and Latino people with chronic illnesses. Even folks with employer sponsored insurance are seeking less care. Costivative deductibles, copays, referrals and prescriptions, as well as the difficulty of finding in- network providers and timely appointments make using those benefits of Pipe Dream. Now, guys, i don't have the numbers in front of me, but I have insurance through work and it's like a really good plan. I think they take like 800. 
Dollars a month from my paycheck for the insurance, and then I, probably in a given year, have to pay close to two to 3 thousand dollars out of pocket. 
For doctors and stuff that aren't covered.

So I have insurance and I don't know you could do the math on that like 800 bucks a month, a few 1000 dollars a year. It's a lot of money. Guys. I could be buying merch guitar gears, snacks, flip-flops, themed crocs, new underwear, so many things with that money, but instead it goes to me just like being a reasonably healthy person. Today one in three gofundme are raising money for medical bills and now the media likes to talk about this like theyre feel goodod stories of communities protecting their own. But thatlies the really dark reality. Because only 12 percent reach their goals, 16 percent get no donations at all guys. This is clearly not a viable substitute for health insurance. And today. 

62 percent of American bankruptcies are due to medical bills. It's really upsetting. It's I don't know how patriotic I am anymore. I think I changed my mind from what I said earlier in the video. I'm skeptical about this whole. 

America Thing, according to Aliceison celso. 

Director of the charity RIP Medical Debt. The problem is that the US healthcare system is a tugof war between hospitals trying to get paid and insurance companies trying to pay them as little as possible. Now, hospital costs are intentionally inflated through the negotiation process with the insurance companies and private insurers can only negotiate down so far depending on how much market power they have. What's more, insurers don't have that much incentive to put a ton of effort into negotiating in the first place, they can simply pass any price increases back onto the consumer. Indeed, even when dominant insurers are able to negotiate prices down while hey kids, they just pocket the surplus rather than passing the savings back to patients. Because health care is a for-profit thing where people are making money in the market and on executive boards. 
Because we get sick. That's how it works. Guys, i know that sometimes you're like. Oh, it's woke, crack now or whatever, and listen. I get it. We don't all have to be Marxist or anarchist, or sort of democratic, social or whatever. I totally get it, but can we all agree? Can we all just agree that it's maybe bad to have a system where people make Money off of us getting sick where it's beneficial for us to get sick and they will make surplus profit off our illness. Let me just think about it for a second and let me know down there.

What's more? Private insurers will try to pressure healthcare providers not to offer their competitors discounts, which artificially inflates prices across the board. I know this is all a little bit wonky, but here's the gist. If the system is a Tugof war, insurers are often barely given the rope a real yank, which is why we say. 

Just yank the rope. Meanwhile, massive consolidation of hospital networks is giving them more muscle power and destroying competition, which makes the negotiation process a lost cause for insurers. 

Now the government has ways to eke out reasonable Medicare and Medicaid prices, but in turn, hospitals will often cite low earnings from those programs as the reason private insurers are charged so much more an average of 200 and seven percent of Medicare prices. But the data doesn't bear that out, and Wiley concludes that there's actually no relationship between a hospital's share of patients that are on Medicare and Medicaid and the hospital's prices. Meanwhile, hospitals also use their bargaining power to do things like make insurers promise not to steer patients to lower cost. Hospitals and some major hospital networks effectively act as a tax on everyone with private health insurance, and this tax is spread equally across demographics. As Duke University law professor Barack Richmond puts it. Family that is earning 40 thousand dollars is paying the same in premiums as a family that's earning four million dollars. What's more like all these young people are the most continuously. 

By the whole debacle, and it's like they're part of a human centipede of healthcare cost-induced Pain. If you have not watched the movie Human. 
Centipede we start with cutting the ligaments of the nica. Please never watch it. As Kofianpa Bang and Elise Amezros wrote in Fortune Today, the rule is simple. Elderly reap more in benefits than they paid into the system. The current young generation stands to pay more than they'll one day receive. Because young folks are less likely to have employer-based health insurance, they usually have to pay for their own, which typically costs more than all health services they'll use in a given year, not even counting deductibles and coppas. It's a sandwich garnished with more SH dipped into a little cup of warm pea. Meanwhile, the healthcare industry is working hard to keep things this way, spending more than any other industry on federal lobbying. This led medical journal JAMA Internal Medicine argue that the industry wields a disproportionate influence over. 
Health policy decisions. Collectively, they shelled out 700 and 14 million dollars in 2020 alone, a leap of 70 percent since 2 thousand, largely in response to the ACA right behind them.

The second highest spenders are the insurance industry, of which health insurance is the leading sector. They do super fun and chill things like aggressively opposing legislation that would have cracked down on insurers' frequent rejections of mental health and addiction treatment claims. Guys. I cannot tell you how many times I've submitted like therapy or psychiatry stuff to the insurance and they're like, no way, why would we pay for this? You're getting legitimate medical service for a condition that you have. Why would we pay for that? Mr. Blue Shield if you're watching shame on you. One salient example came in 2020 when Washington State tried to prevent health insurers raking in enormous profits from hiking prices for consumers. According to one representative, the state's top three insurers helped write an amendment that. 

Successfully weakened the bill bottom line. There's just an unhinged amount of money flowing into federal and state governments to encourage policy decisions favorable to folks profiting off the current system. 

Back home for some free surgery where medical matters are concerned. It wouldn't matter in Canada what party you were affiliated with now. Obviously. Canada and Great britain's healthcare systems are struggling and becoming increasingly politicized, but their systems still operate under the basic expectation that membership in a society comes with some amount of protection. That's not a rare concept worldwide, either. 72 countries have some form of universal healthcare. If you're from one of those countries, let us know in the comments and let us know what that's like, you know, because we have no idea. South korea's government covers up to 60 percent of all medical expenses, which many supplement with private insurance. Brazil, for its part, offers free health care to anyone within its borders, regardless of citizenship. What's more, these countries are typically spending much more of their money on preventative care. That is, they're treating people before they've developed expensive chronic conditions which is more cost-effective. And also, you know. 

Nice for people with these alternatives, it's no wonder that Americans are just Jones for Universal Healthcare. 64 percent of Pew Survey respondents agreed that it's the government's responsibility to ensure healthcare access, whether through a single-payer or mixed system. Unsurprisingly, young people are the most gungho about this now amongst the. 

Proposed solutions is Medicare for All which would create a system where the government rather. 

Than our lethargic private insurers would. 

Negotiate healthcare costs for all of us now, the expansion of Medicaid under the ACA is arguably its best legacy, so it's no wonder that this seems appealing and just this week, several big pharma companies agreed to start negotiating maximum drug costs with Medicare for the first time in accordance with the Inflation Reduction Act, making crucial medications affordable to those who qualify healthcare providers. However. Worryrri that expanding Medicare to everyone would be disastrous for healthcare facilities who would no longer be able. 

To aggressively overcharge privately insured folks. But of course, it would be a literal lifesaver for the millions of uninsured and underinsured Americans, as well as those of us who have insurance. But honestly, you just can't really afford to use it now. Other rich countries around the world are spending half of what we do per capita on healthcare and seeing much better outcomes, proving that these systems save money and lives. I think lives are probably more important, but it's good to save both. Those who defend america's current system of healthcare often cite the importance of market competition in keeping any industry's prices in check. But as we've seen, healthcare and health insurance simply don't work like most industries, and when we try to make it, we end up with a cartel-like system that makes breaking an arm or a leg basically cost you an arm and a leg. The business of saving people's lives is simply too important to be left to market forces. Now, obviously overhauling america's healthcare system would. 

But when you consider just how young our system is, remember the first insured teachers hosni up 50 cents a month less than 100 years ago, it starts seeming a little ridiculous that we would hold so tight to a model that's so blatantly flawed. But what do you think about? All this is america's pricey and ineffective healthcare system? Just inevitable is radical change possible, or is our ability to get colonoscopies always gona be at the mercy of the market?