David Smeared as ANTI-Medicare-for-All

Hey, so this, this is really concerning and
it goes to the heart of what I’ve been talking about for a while, the last few years about
purity tests and self destructive behavior. By the left. Um, I did a video a few weeks ago where I
said I’m for Medicare for all. I’ve been for it for a decade. I think it’s one of, if not the best option,
it’s a crisis that we have medical bankruptcy in this country. I mean, I want to see this happen, but it’s
going to be way harder than simply Bernie becomes president and we get Medicare for
all and we need to know that and we need to be up for that fight. And there were a bunch of people who wrote
to me who said, David being a defeatist, you’re a centrist shill. You’re providing cover for not advocating
for Medicare for all. And of course, none of those things are true. And I wasn’t doing any of those things. Now, people who have been watching this show
for awhile know that not only am I for Medicare for all, I’ve been advocating for it publicly
on this program as Medicare for all since at least 2015 but remember that Medicare for
all is a term that became more popular in the last four years. Even before that we were really talking about
the same thing when we were calling it single payer. And in that sense I have been advocating for
this since 2011 publicly if not longer. Uh, then over the weekend in a compilation
video of some kind, I don’t know the orange origins of this video or the oranges of it,
to quote Donald Trump, it has about 50,000 views. As of this recording, my video comes up in
a compilation of people who do not support Medicare for all, including Joe Biden and
peed Buddha judge, and at least as framed by this video, Elizabeth Warren, I am included
as an opponent of Medicare for all. Here’s a few seconds of this video, which
includes audio of my clips, sort of mixed in with other people who are not for Medicare
for all. Take a look, a voter’s choice to opt in to
care for. I am here to talk to [inaudible] guys. If I’m the enemy, we’re not going to win. If I, as someone who has been calling for
single payer and Medicare for all for nearly a decade publicly, the videos are up. If I am the enemy because I refuse to Gaslight
my audience and I choose to be real about what it will take to get Medicare for all. If I am considered the opposition to Medicare
for all, we will lose. We have lost, we’ve gotten so far down this
with us or against us. Everything is black, white rabbit hole that
uh, uh, I am being included in a compilation of opponents of Medicare for all. And this is how allies get pushed out. Okay? If I’m on the wrong side of this, then consider
who is on the right side. I mean, almost no one, right? If you’re against Medicare for all, you’re
of course on the wrong side. And I agree with that. If you think Medicare for all simply can’t
work economically, you’re on the wrong side. There may be some tweaks that have to be made
to the proposals and I’ve pointed them out, but if you just simply think it doesn’t work,
you’re on the wrong side. It works in many countries. If you’re okay with Medicare for all, but
also okay with other other systems according to this black white litmus test, you’re on
the wrong side. If you’re for Medicare for all but like me
believe it is going to be way more difficult than some on the left are willing to admit. Apparently you’re also on the wrong side. If you have like me been advocating for Medicare
for all publicly for a decade, but you believe there are too many people who misunderstand
what it will take to get there. I guess I’m also on the wrong side, so who
are you left with? This is how you get a purity test. We’re the only people on, I guess the right
side are those who are not only for Medicare for all at the exclusion of any other idea,
a priori, but who also shut their mouths and don’t get real about what it’s going to take
to get there, including recognizing that Bernie becoming president alone isn’t going to do
it. I guess my choices now are because I’ve been,
by virtue of doing a realistic assessment of what it will take, pushed into the anti
Medicare for all camp, I can either comply with the purity test or shut my mouth, right? I mean, what I need to start broadcasting
Medicare for all is the way, and if we elect Bernie, we will have it in four years. Even if I believe that to be absolutely untrue,
especially if the first two of those years we don’t even have control of the Senate. Is that what I’m supposed to do? Tell what I believe to be lies to my audience. That’s not what I do, right? I call things as they see them. I’m a supporter of Medicare for all. I’ve been one for a decade. But if this analysis is what gets me branded
as an enemy of Medicare for all, what are we even doing to our movement? What are we doing to ourselves? If I’m the enemy on Medicare for all, Trump
is going to get himself reelected and sweep. I mean this, it’s just such a misguided, uh,
effort. Republicans, you know, Trump does insane,
dangerous stuff and Trumpists laugh and they don’t care. And they say, Oh, it doesn’t matter. But then I can’t even talk about the difficulty
of Medicare for all without getting smeared as being against it or hurting the movement
because I’m being realistic. Say hello to another four years of Trump. If this is what our movement is doing, it’s,
it’s heartbreaking. It’s so sad. Um, but I don’t even know where to go. [inaudible] it’s the, the idea of me being,
you know, the enemy on this issue tells us that at least for a sliver of the left, and
I don’t believe I got a lot of positive emails and, and appreciation for my commentary, but
at least to a sliver of the left, uh, merely realistic assessments are now considered
being on the other side. We’re in trouble, folks. We’re in real trouble.

Defining the ‘All’ in Medicare for All

The 2020 election has put “Medicare for
all” on center stage. And we got to pass a Medicare for all, single-payer
system. Getting to guaranteed, high quality universal
healthcare as quickly and surely as possible has to be our goal. Medicare for all solves that problem. It’s no secret that many are unsatisfied
with today’s healthcare system. Nearly 11% of people under 25 are uninsured. Nearly 16% are insured, but struggle with
affordability. So it’s no surprise that Medicare for All
has broad support among the public, at least according to some general polls. The specifics get a bit trickier and that’s
in part due to terminology. There’s general confusion over the interpretation
of what is covered within “Medicare” and who is covered by the “all”, even among
the policymakers themselves. Why do you have to go all the way to Medicare
for all? But again this is what I’m saying. First of all a lot of people use that terms and there’s
differentiation about what they actually believe. Established in 1965, Medicare is a federal
health insurance program for people 65 and older, and 54 years later, it’s ranked as
the second most important government run program, after social security. Medicare for all as a concept has been around
for decades, but today, some policymakers are using the term pretty loosely. Very similar. I would call it medicare for all who want
it. You take something like medicare, a flavor
of that, make it available on the exchanges. Within the health care community, the definition
of Medicare for All is quite exact: a government-funded single-payer health care system. Basically, insuring everyone under one public
health plan. I believe in a healthcare system that guarantees
healthcare to all people in a cost effective way, which is what Medicare for all is. Of all of the varying health care plans being
proposed, there are two that stand out as aligning most closely with the original health
care community’s definition: those are the plans put forth by Senator Bernie Sanders
and Representative Pramila Jayapal. Their plans move all U.S. residents — into
a new and essentially unrecognizable Medicare program, eliminating premiums and virtually
all cost-sharing. The public plans covers a lot, including vision,
dental and prescription drugs. And with this newest version of Sander’s
plan, both now covers long term care. Medicare for all would pretty much eliminate
private insurance. So, the idea is that everyone has access to
the same doctors and the same kind of healthcare. The bills don’t specify how much the government
will finance free health care for all, so it’s hard to know exactly how much it’ll
cost the government or you. Tax increases are likely, but who and how
much are still to be determined. And some of those taxes could be offset by
the disappearance of premiums and medical bills. Today, 160 million Americans are insured through
their employers, so eliminating nearly all private health insurance would dramatically
disrupt the current healthcare system and essentially create an entirely new one. And concerns about that disruption are reflected
in the polling. While there’s broad support for Medicare
for all generally, when polls asked specifically about eliminating private health insurance
plans, that support dropped significantly. Senator Klobuchar, you’re one of the Democrats
who wanted to keep private insurance in addition a government health care plan. Why is an incremental approach in your view
better than sweeping overhaul. I’m just simply concerned about kicking half
of America off of their health insurance in four years. Other lawmakers, wary of the massive overhaul,
developed plans to keep private health insurance as an option. I think this plan has the ability to unite
Americans, some of whom may not be ready to adopt a medicare for all system overnight,
but who do want the option to choose for themselves whether they get into the medicare system
and can’t today. Three propose the creation of an opt-in government-sponsored
Medicare program while maintaining private plans, so people have the option to buy public
insurance if they want. They cover roughly 60-80% of medical costs,
depending on how much patients earn. Unlike Medicare for All, patients continue
to pay premiums for health care. The biggest difference between the plans is
how people would access the public option. On one end of the spectrum, employers get
to decide if they would allow employees to buy public insurance. On the other, only smaller companies would
be allowed to provide that option. Larger companies would be barred from the
exchange. Then, in December 2018, Rep. Rosa DeLauro
(D-CT) and Jan Schakowsky (D-IL) tried to strike a middle ground, which eventually moves
everyone into a public plan. I am also the co-sponsor of Medicare for America. I am for improving it, I am for all the plans,
because what we have now is not working. Under this bill, who participates in the public
option would change over time. Anyone who’s uninsured, gets insurance through
the Obamacare marketplace, is on Medicaid, and newborns, would automatically be enrolled
in the public program. That means that eventually, everyone would
be enrolled, and employer sponsored programs would be phased out. Patients would still pay premiums and out-of-pocket
costs, but those would be calculated on a sliding scale based on income. If we were to start from scratch, maybe we
would start with a single payer, but we’ve got to start with the system that we have
here today. The surest, quickest way to get there is Medicare
for America At the other end of the spectrum are the plans
that really can’t be confused for Medicare-for-All, but would still be considered expansions of
the current healthcare system. One plan would make Medicaid, a program primarily
for low-income people, available to everyone. Another plan would lower the age requirement
for Medicare by 15 years. This goes right to that group of people that
have the most concern and anxiety about whether they’re going to have affordable healthcare. The array of health care plans proposed is
large and varied. And with such a complicated system, it can
be hard to keep track of subtle policy differences. So the next time you hear a candidate proposing
Medicare for All… medicare for all
medicare for all medicare for all
medicare for all medicare for all It’s best to ask for specifics.

Democratic Platform Drafting Committee Votes Down Single Payer Healthcare

Thank you Mr. chairman. On page 21, line 5 we would like to add the following
amendment: “It is the policy of the Democratic Party
that we will put people before profits by fighting for a medicare-for-all,
single-payer healthcare system to guarantee healthcare as a right, not as a
privilege, to everyone in this country. Working together we will end the greed
of health insurance companies.” Is there a second to Mr. Zogby’s… there is a second. Now would you like to explain that? I
would like to explain it. We heard quite compelling testimony duringour session that dealt with this issue. In particular from nurses who told
stories of patients who could not receive adequate care because they
lacked insurance. One nurse in particular told of her personal story of how
even though she is insured because she has a son with autism she could not get treatment for herself. The cap on what her insurance would
cover was exceeded by that and so she herself was doing without healthcare. That is unacceptable in our country and
I believe that what this amendment calls for is an aspirational goal toward which we
must work. And that is that healthcare is a right and
that we place it above profit. It is not a business. It is the business of
America should be caring for our people and making sure they all have health
care. It’s been a goal of our party since FDR
and in successive administration’s we’ve tried. We passed the Affordable Health Care Act under President Obama and a Democratic
Congress. And I will tell you I wept the day it passed. I have a daughter who
has a granddaughter… I have a granddaughter – the daughter of
my daughter – who has Down syndrome and leukemia. The thought that she would forever be
able to get health insurance because even though she had a pre-existing
condition she could not be denied was very significant. And when the
Supreme Court affirmed it I wept again. It is important that it
passed and no doubt there are is progress. More people now have
health insurance than ever before. Kids under 26 can continue to get coverage by
staying with their parents and we do have advances that have been made but
we’re not far enough along the way. If people in Canada, the UK, Germany, France,
Scandinavia, Holland, Japan, etc – if they can have healthcare as a right we can in the United States as well. When
we pass a medicare-for-all plan every American will have the freedom to go to
a doctor when they need it without worrying about premiums, deductibles, or
fighting with insurance companies. To me it’s unimaginable that we’ve gotten to where we are today that what when my daughter
would get the bills from the hospitals that they be in the 60, 70, 80 thousand
dollar range for just a few days treatment. Thank God the companies were covering
it, but what if you don’t have coverage, as many people don’t. And how much money is being made by the
companies and the hospitals in this system that has gone completely out of
control. Parents shouldn’t have to worry about
how to take care of their kids. People who are under 50 should have the
same assurance of coverage that folks over 50 can have because of Medicare and
Medicaid. The fact is that we need to consider
this. Now there’s a lot of arguments that we’ve heard on our side and on
your side about why this may not be able to be done and why we ought to stay with
what we’ve got and continue to tinker. What we’re proposing is an aspirational
goal – where we ought to be, where we want to be, the target that we ought to be
shooting for. It is medicare-for-all, it’s insurance. It’s putting people before profits and it’s making sure that all of our people
receive the coverage that they deserve because they’re our people. With unanimous consent I’m gonna make this a five-minute you have a minute and a half for the… well Mr. Ellison. I said you got a minute and a half. No I’m asking if we need to second his motion Oh he got one, sorry. I wanted to just say very quickly look you know one of the proudest
moments of my life is when I got to vote for the Affordable Care Act. It was great, it was awesome, I’m so proud
of it, but here’s the thing it is based on a private insurance
system, it’s based on that system. And many of us fought hard for a public option
that didn’t prevail. I think that the reality we live
in today is there’s a 6.5% inflation projected for 2017 in medical inflation. We don’t see the double-digit inflation we saw in the past, but we do not see the declines that we should. And this
is because we’re still tethered to this private insurance system, which I think
creates a real problem. And personally I think this is a laudable goal for us
because at the end of the day, if medical inflation just keeps going up, it’s going to strengthen the hand of
those people who want to attack the ACA. I think if we’re not moving
forward then we’re going to be moving back. And because we don’t have a public option a single-payer goal, we are subject to
whatever the private sector wants to do. So with that I’ll vote yes and I urge
other people to do the same. Anybody in opposition? Anybody in opposition? Mz. Tanden, Opposition now has five minutes and then
i can go to you Mz. Lee because you come under the party. So first of all uh I don’t really want to couch my comments in opposition because everyone in this room,
every single person in this room has fought for healthcare as a right. We all
fundamentally believe health care is a right. We all believe that
we should put people people before profits. I will offer an amendment as well, and I really want to acknowledge what Congressman
Ellison said, which is that the Affordable Care Act was an
accomplishment. But i also want to acknowledge that the question before us is not just the Affordable Care Act or
some other goal. The questions before us are how to
accomplish the task of ensuring everyone has health care. For example, we have
language on a public option. There are steps we can take to build on
the Affordable Care Act to meet the goal of ensuring health care for every
American. And there has been important steps on savings and costs, but
there are other steps we can take, which is what the language in the platform has today. But i want to say that I would like to offer language
acknowledging that Democrats all agree that health care is
right and that it’s not a privilege; that it is something that every American
should have, every person should have. You know I completely agree that this has
been a right that we have fought for, presidents have fought for year in and
year out, and it is a true accomplishment. And I acknowledge the
voices that we heard from who are concerned about the current system, but I do have to add the voices that I know we all care about: voices of
people who are alive today because of the Affordable Care Act. But I
say that recognizing that I assume most people in
this room support the Affordable Care Act. It was a
proud accomplishment and my view of this is that we should not
accept the status quo, that we should all of us work together to actually pass a
public option – ensure there is an option of people to buy into Medicare.
Steps we can take to improve upon the Affordable Care Act to reach our shared
goal of universal healthcare and healthcare as a right for every person
in the country. And so I speak against this amendment, but I really share the
goal of ensuring that we do cover every person and that they have
the assurance of health insurance that works for them whenever and wherever
they need it. Anyone else in opposition? Anyone? Rebuttal Yea, Mz. Lee, I’m sorry. Thank you very much. You’re opposed? No, I’m in support. First of all let me just say I agree with what everything what has been said by both
sides tonight. I did help negotiate the ACA and I’m
very proud of what it has accomplished I wanted to make sure that whatever
amendments came forward did not affect or exclude those who were covered
under the ACA and this amendment i think is a good amendment. It builds upon the ACA. We’ve got to do more And you know my mother, my late
mother told me where there’s a will there’s a way. And so I think this is very clear here. I think it states very clearly not necessarily how to get there but it is aspirational – where we want to go – and I
would just ask that instead of saying “end the greed of the health
insurance company” say “of the big health insurance companies” if that’s okay with you Mr. Zogby. Is that a friendly amendment? That’s a friendly amendment. I accept the friendly amendment. Ok, thank you very much. I think this
is a good amendment and we got to do this. It’s a matter of life and death for
so many people and we’ve got to go further, so thank you very much. Anyone else?
Anyone else? Alright. The rebuttal time? Yes, Mr. Zogby. I’m looking
at the amendment you’re going to propose and it reminds me a lot of the
same way that we approached the environmental issues, which is we agree
it’s important, it’s got to be done, but any effort on
our part as Democrats to define a way forward, i.e. medicare-for-all in this instance, or
a single-payer plan, we won’t talk about. And so I urge you to
consider voting for this because I believe that it is not only an
expression of where we want to go, but a way forward to get there. And I therefore rest my case. Can I respond or do I do that in my amendment? You can respond, go ahead. A rebuttal to the rebuttal? I’m going to give her just 30 seconds. I would just urge you to look at the
language within the platform and consider the steps within the platform
that also try to reach our goals. And I appreciate that we might have different
manners by which we get there, but I hope you recognize that many of us have been
working on this together. I have worked with members of Congress
on the ACA and other steps and that we have steps here in the platform to not just accept the status quo, but
move beyond it to get to healthcare for every American that is affordable,
reliable, and something everyone can be secure in. Ladies and gentlemen, time is
expired. Time to vote. All those in favor of the motion please
raise your hands. All those opposed. 7-6. 7 against, 6 for. Next.

Is Bernie or Warren’s Medicare for All Plan Better?

Let’s go next to our caller from the seven
Oh eight area code. Who is calling today from seven zero eight. Does that mean? Yes, it is. Hello. This is Isaiah from, uh, Chicago. You
know, I saw on a backlash you got over the last two videos about the Medicare for all
right. No, we’re never gonna get it and that, well, not never, but it’s going to be awhile.
It was my point. Yeah, but go ahead, Isaiah. No, I saying like, um, with me not being really
inspired to be even trying to vote in 2016 because those both candidates were so uninspiring
and as with me so than with millions of people around, like we feel like it’s a realistic
change within voting for Bernie because of the things that he has promised has seen so
much realistically. So if you know what the damper of the fact that we would never get
it. Do you feel it that way, like turn voters off from getting into uh, trying to vote for
Bernie? No, I w I w my hope would be that it would
actually get people to do more than just go out and vote for Bernie in the sense that
if you recognize that there’s going to be way more to the fight for Medicare for all
than just electing Bernie, for example, that it’s going to be about, you know, someone,
someone emailed me and they said, you know, David, even if we take the Senate and we get
60 votes, if only 10% defect and say we don’t want Medicare for all, it still wouldn’t pass.
And so that’s why this is going to be a much bigger fight. I would hope that people would
say, Oh, getting Bernie in is just step one. Then I’ve got to work at the Senate, I’ve
got to work on governorships. I’ve got to lobby my member of Congress. You know, there’s
a whole bunch of other stuff that hopefully people would be inspired to do. The idea is
we’re going to need to do more than just elect Bernie. We can do it, but we’ve got to do
it. It’s not just Bernie comes in and we’ve got Medicare for all. That’s my point. I have one more question. Oh, that was a good
point as well. But on the Republican side of things like we’re burning, we’re bringing
it back to Republicans that Bernie saying that he would have Medicare for all bill.
That’s changed. Like everybody stands. Like that’s something that you gotta have cause
it’s like, Oh, I’m running for Medicare for all. So what is a Republican run for in 2020
to try and give on? It’s like, besides Donald Trump’s last, what could he really say to
spark his side of voters besides the last that he’s already taught? Are you saying if you’re Donald Trump, what
do you run on in 2020? Or if you are another Republican, what do you run on in 2020? Oh, Donald Trump. Oh, Trump runs on, we know what he’s doing.
He’s running on keep America great. He’s running on the economy’s fantastic and we’re respected
around the world and we’re doing the trade deal. The U S I mean it’s all lies, but that’s
what he runs on. And if 62 million people fall for it, as long as they’re in the right
States, he wins reelection. Okay. What’s the for that, David? All right, I appreciate the call. Thank you
so much, Isaiah. Let’s go next to our caller from the three zero five area code color from
three zero five. What’s your name? Where are you calling from? Hi David. My name is Michael and Colin from
coral Springs. How are you? So I was wondering, David, I saw your video like the previous,
um, previous caller in, uh, on Medicare for all and it’s unlikely hood, um, to pass. So
I was wondering, or actually I was actually commenting on something I thought you might’ve
framed as being, uh, or framed, uh, wrong and possibly made, uh, you sound a little
bit too dismissive about Medicare for all. So that is, that is, um, I was wondering,
is it not true that Medicare for all does not seek to ban private insurance, but the
main operation of private insurance or private health care insurance in this economy, which
is, um, duplicative care, what will is what it would be actually, and I know that came
out really wrong, but no, you’re completely right. It’s, I, it’s
been of widely incorrectly stated claim that Medicare for all by necessity will ban private
insurance. I don’t believe that that is the case, but I’m going further. I’m saying that
to the extent that it is, uh, something some people want to do, uh, I don’t see legally
how you do it, but you’re completely correct. And I’ve made this during debates. It’s not,
I don’t, I don’t believe most of the candidates are looking to make private insurance illegal
that that’s correct. I think that they shouldn’t try to, I think they wouldn’t be able to and
it’s been misstated before that, uh, they all want [inaudible] [inaudible] but there’s
also a mathematical reality, um, of unless [inaudible] you have, uh, all service providers
accepting Medicare for all that changes the numbers. And it was, it was not an argue if
it seemed like I was saying their goal is to make, uh, private insurance illegal. I
was not seeing that. Thank you so much. That is exactly what I thought. No, I appreciate
you clearing that up. Uh, that being said, last question if that’s okay with Elizabeth
Warren now detailing her plan on Medicare for all, and I understand the point that you
were making an other video or one of the points being that either way, all of this is the
Medicare for all is going to have trouble going through Congress. I wanted to ask as
well now, uh, now that you see Warren’s plan for it, do you see Bernie’s plan for it? We’ve
seen it for a long time now. What do you see as more viable and does that possibly make
you lean towards endorsing one of them in the future? I don’t see either of the plans as politically
more or less viable because I’ve already pointed out much to the dismay of many in my audience
that in either case in either configuration politically it will be a huge Hill to overcome.
I believe that Elizabeth Warren’s uh, uh, cost assessments, we’re more unrealistic than
Bernie’s. I have a problem with the way Bernie is assessing predicted costs, but I think
Elizabeth Warren is even more off the Mark with it, but they are big picture. They are
pretty similar plans in terms of uh, what it, what it would cost and what would be included.
The how Elizabeth Warren, uh, would pay for it. There are some differences there, but
we’ve got a long video about this which I encourage you to check out. All right. Thank
you so much David. I appreciate the call. Thank you. You too. Great to hear from you.


It really pains me to have to talk about this
today. It really does. But I’m really worried about a faction of
my audience and, and quite frankly, I’m really worried about the left and this is not concerned
trolling. I’m worried because of the response to a video
that I did yesterday explaining some unfortunate realities about Medicare for all. I did a video yesterday where I explained
in no uncertain terms, we’re not getting Medicare for all anytime soon. Now there are lots of good progressive takes
that agree with that. One example is a progressive economists, Dean
Baker’s recent comments about Medicare for all he, he is a progressive. I had him on the show recently. There was no question about it. I did the video in good faith. I said, listen, I’m for Medicare for all. I believe Medicare for all is the gold standard. I want Medicare for all. I’m not suggesting that we push lame centrist
policy because getting Medicare for all will take much longer than some people think. I’m not suggesting that we don’t hold our
candidates accountable to the gold standard. That is Medicare for all. But I explained to some unfortunate realities
about Medicare for all with the hope that once we all understand these, we can be stronger
in our advocacy for better policy as activists, as media people, as voters, people in the
audience. The video I did is about 10 minutes long and
I expected that there would be some comments and David, you’re kind of being a defeatist
here even though it’s not what I’m, what I’m actually doing. Uh, but the reaction has been, um, again,
it’s just from a piece of my audience. A lot of people understood what I was doing
and appreciated it. Three minutes after the video was published. Remember the video is 10 minutes long, three
minutes after the video was published. It had 50 dislikes. It’s only been three minutes. You couldn’t possibly have watched the 10
minute video. Even if you had it on double time on YouTube
in the three minutes it took 50 people to dislike the video. And there are either people who didn’t watch
the video at all or people who just watched it and don’t understand what I’m saying or
people making bad faith arguments. But I am very worried because if that is the
contingent that the success of our movement depends on, we will lose. And I hate to say that. Let me give you some examples and um, uh,
again I’m doing this because I want to win and I’m worried that there are factions in
our movement that are totally misguided and their reactions to, to, to people simply saying,
Hey guys, we should be aware of this stuff. One example, I’m not surprised David is shilling
against Medicare. I actually say in the video probably close
to a dozen times I am for Medicare for all this is either an ignorant or a bad faith
comment. Another user responded, Bernie can establish
a state of emergency and sign it into law. Trump has set so many precedents. Listen, this is where the the the, there is
an element of the left that is in a fantasy world. We are not going to get Medicare for all established
through a presidential state of emergency. I understand that there’s some hypothetical
world in which president Bernie Sanders says, our uh, healthcare situation is so bad that
I’m declaring a state of emergency and during that state of emergency I am going to simply
create Medicare for all and then boom, we will have Medicare for all. It’s just unrealistic. Okay? It’s not worth even putting energy into that
and responding to what I’m talking about by saying, David, Bernie will just declare a
state of emergency and create Medicare for all. It’s not happening. We are not going to win if that’s what we
are hoping for or waiting for. Another example, this was a very bad take
and a bad faith argument. David [inaudible]. What was bad faith about it? They don’t say, this sounds like a Nancy Pelosi
speech. Please go back to being more progressive. People liked you more that way. I mean, listen, the show is bigger than ever. It’s more than doubled in the last year, but
that’s not really the, actually don’t think that’s the issue. That doesn’t tell us whether I’m right or
wrong. The idea that it’s a bad faith argument when
I’m saying I’m for Medicare for all, we should still push for Medicare for all. We should demand our candidates before Medicare
for all. That is what seems like bad faith to me. Uh, another comment. Okay. So David is basically advocating for centrist
policies so that we have a chance in the future. No, I literally say in the video, I am not
suggesting that we advocate for centrist policies. I say it in the video. So again, either people aren’t listening or
they’re making bad faith arguments. And lastly, now is the time to unsubscribe
from this channel. Do this to be making a point. No progressive should ever be posting against
Medicare for all. So again, number one, I say a dozen times
in the video, I’m for Medicare for all. But more importantly, that is the sort of
black and white thinking, these these bogus litmus tests that are not connected to reality. Not only am I for Medicare for all, I’m trying
to figure out the right way to get there. One idea I had is it’s more likely to start
with a state doing Medicare for all. That was one example that I gave. Now, fortunately I did get some emails from
people who took the time to email me and say, David, I know you’re going to get crap for
this, but you’re right and I think it’s good that you’re doing it. We need to be more armed with facts so that
we can better advocate for what we want. There were a few YouTube comments that that
seemed to understand what was going on. One who said these comments show people don’t
listen to what he’s saying. Yeah. Another comment or who said the comments are
depressing. Watch the whole video. He supports Medicare for all. He’s talking about strategy here. He’s talking about reality. He’s right. He’s saying it because people need to know
the reality. We need realistic expectations and knowledge
about how the system works, so listen, I’m not being, I’m not acting in bad faith. I’m saying a Bernie presidency doesn’t get
it for us, for all of the reasons that I cited yesterday and more I want it. I think it’s the best. Listen to what I’m saying. It’s not impossible. It’s just way more work and we need to know
that going in and we aren’t going to succeed in any of this. If we imagine such delusional things, as Bernie
will say, we have an emergency and put in Medicare for all, it’s not going to happen. It’s not going to happen. An any time wasted expecting that or suggesting
that is time that you are distracting from doing the real work that needs to be done. Prove me wrong. I want to be wrong. Okay? This is one of those things where if in three
years we have Medicare for all, I will gladly show up and say, you know what? I was skeptical but I was wrong. You all great activists prove me wrong and
we have Medicare for all. I hope that that happens, but it’s not going
to be closer to a reality if the reaction is David, you shouldn’t even allude to the
fact that it might be more difficult than some people are making it out to be. Spend the time advocating for a groundswell
of progressive candidates at all levels, all of whom want Medicare for all so that we can
take back the white house and the Senate and governor’s mansions and the Supreme court,
which will be crucial in actually getting working Medicare for all. But if the reason, uh, if the reaction to
me being realistic is, David, you’re a shill. You’re a bad person for doing this. You shouldn’t be saying this, I’m now a right
winger or a centrist or whatever. We will lose if we attack people who agree
with us on policy, not because they even disagree on one policy, but because they differently
assess its path to reality, they will crush us. They will crush us. We will lose if that’s what we do. Mark my words, we will forget about Medicare
for all. Trump will get reelected. We will not get the Senate. It is upsetting to see, and I’ll go even further. I’ve talked before about how our system is
set up to prevent people from really activating what we really need are mass rallies in urban
centers. We need to consider strategic defaults to
cripple the financial system, mass work call-outs to cripple industry, serious forms of protest. But as I’ve said before, the system is designed,
designed so that no one can afford to do that by keeping wages stagnant, keeping public
transit terrible in most places. And the rest of it, we’ve talked about it
before. Let’s work together because the reaction to
yesterday’s video from this piece of my audience is how we end up accomplishing nothing. And I don’t want to accomplish nothing. I am not suggesting we give up on anything. Should we fight for Medicare for all? Yes, we should. Should we always start negotiations from the
morally correct position that we actually believe in? Is Medicare for all of course, but responding
with kill the messenger too. I think some people are missing the reality
of how this becomes, uh, the law, how this becomes our status quo. It’s toxic and it will destroy the left, which
I don’t want to see and I would actually argue that the left has already been hurt by the
significantly on the positions we are already with the majority of the country. Every poll tells us on healthcare, we are
with the majority on gun safety. We are with the majority. One of the reasons there are many reasons
and many of them are structural and know gerrymandering and campaign finance. One of the reasons why we have not been more
effective is this infighting that exists. When someone says, Hey, I’m with you on everything
except I disagree about how easy you think it’s going to be and here’s what we need to
know. We’re going to lose, we’re going to lose and
I don’t want to lose. Tell me all the ways that I’m wrong. If you can actually keep it issue-based. I’m on Twitter at D Pacman. Leave a reply below. I’m sure that there will be more followup
about this upcoming,

Medicare for All Isn’t Happening (Soon)

I hate to have to start this way today after
the Thanksgiving holiday. But if you’re watching on YouTube at least
wait, please don’t hit [inaudible] the dislike button just yet. Consider watching this video first. Before you do that. I am here to talk about the unfortunate reality
that a national Medicare for all is not happening anytime soon. And I’ll explain why and I’m not here as an
opponent of Medicare for all. I’m not someone who wants it to fail. I’m an advocate of Medicare for all, but I’m
also an advocate of being realistic with you if we want to make things happen. And the reality is that without me attacking
Medicare for all, without me attacking the concept of Medicare for all, I recognize that
national Medicare for all isn’t happening anytime soon. I’m not here to say we should advocate for
centrist policies that are more realistic, that we should advocate for the policies we
think are the right ones. And the right progressive policy is Medicare
for all. But I’m not here to tell you unrealistic things. Like if Bernie gets elected, we’ll have Medicare
for all in four years. We won’t. And I’ll explain why in a second. Our politicians do enough of the unrealistic
stuff. I’m here to discuss the realities and I’m
here to tell you today that because national Medicare for all simply isn’t happening anytime
soon, even if the next president supports it. We need to be smart, so let’s go through this
piece by piece and once we’re done, rather than, you know, calling me a shill or whatever,
tell me where you think I’m wrong on the reasoning because that’s really what this is about. It’s about talking about the facts and reality. Number one, I’ve already talked about some
of the areas of concern around Medicare for all plans, but that’s not really what this
segment is about. Yes. I’ve talked before about how most of the plans
for how to pay for Medicare for all are unrealistically optimistic about how much healthcare spending
per person will go down. If we switch to Medicare for all. In reality, it could take 10 or even 20 years
to see those costs reductions. I’ve talked about that before. That’s not what I’m talking about today. There are political considerations. Even if Democrats take the Senate in 2020
which would be by the slimmest of margins as I’ve outlined for you before, it’s not
going to be enough to pass Medicare for all because number one, even if Democrats do take
the Senate by a few seats in 2020 you need 60 votes in order to pass something like Medicare
for all which Democrats are not going to have after this upcoming election, and not all
Democrats even support Medicare for all in the Senate. You can then look at 2022 but then if you’re
only starting the conversation again, you still need 60 votes in the Senate to pass
this. It’s a question Mark whether Democrats could
even get a 60 vote majority in 2022 and of course the alternative would be get rid of
that 60 vote requirement. You can do that with a one seat majority,
but even Bernie Sanders has hesitated to say we should get rid of that a 60 vote requirement
because it could massively backfire if Republicans take control again when Republicans take control
again. So that’s a serious political obstacle. It doesn’t matter whether Bernie’s president
or Warren’s president or whoever, it’s just a real obstacle and then imagine that you
solve that problem. You have some bigger issues to deal with. We have a conservative Supreme court. We are going to have a conservative Supreme
court for some time. Why does that matter? When we talk about Medicare for all two different
reasons, number one, if you don’t make private insurance illegal as some want to do, it significantly
hurts the financial viability of Medicare for all. Making private insurance illegal would be
almost impossible under the current Supreme court or any Supreme court that’s like it. It will be fought endlessly by moneyed interests
up to the Supreme court. This is not a Supreme court that will say
private insurance is now illegal. It’s just not going to happen and that is
something that will hurt the financial viability of Medicare for all and realistically will
make it not happen politically. Issue number two, you aren’t going to be able
to force doctors to accept Medicare for all. Many doctors will choose to accept private
insurance because again, it’s not going to be illegal and you will see more of a move
to what’s called self pay. We already see self pay more and more in the
mental health field. We see it in dentistry because dental insurance
is terrible in the United States. We could spend much longer on this Supreme
Supreme court issue, but again there is no way that a Supreme court that is even remotely
like the one we have right now would rule. Doctors have to accept Medicare for all. That will be a major problem for the financial
viability of Medicare for all, but it won’t even get to that because it is not going to
be something that you will get 60 votes in the Senate for under these parameters. So what I want to talk about is not that I
think Medicare for all is bad. I think it’s good. I like it. I do see it as a drastic and maybe the best
improvement over the system that we have. I don’t want to suggest to you that it doesn’t
matter if a candidate supports Medicare for all it does. We should. We should support candidates who see Medicare
for all as the gold standard and who see it as the goal, but you and I have to be realistic
that it’s not happening anytime soon. So before we even talk about candidates, let’s
talk about what could happen. Number one, it’s important to get some wins
that demonstrate that conceptually Medicare for all or something. It would work. These include, and this, this is so lame. I’m almost like going to throw up in my mouth
a little, a little bit saying it. We need to support some version of a public
option as an eventual point that we get to. I said during Obamacare, Barack Obama should’ve
started the negotiation for Medicare for all so that at minimum we end up with a strong
public option. We didn’t. He started with the public option and we ended
up with just a massive handout of tens of millions of new customers to for-profit insurance
companies. I know it’s so lame and milk toast to talk
about a public option. And as I said before, all the public option
will do is estimate, say it’ll reduce the cost of private insurance by seven to 9% because
of its impact on the market. But if we end up with the best possible version
of a public option, ideally it will work well because it will be properly set up and funded. We can then point to it and say, look, that
was an improvement. Let’s keep going to the next step. That’s number one. But that’s not all. Number two, it might be possible to make a
change to the Medicare eligibility age, which won’t totally rock the boat. Like for example, lowering the age to 60 or
maybe to 58. This is actually step one in some people’s
plans for Medicare, for all Elizabeth Warren for example, it talks about let’s lower the
age eligibility, the eligibility age, better said in steps and uh, that might actually
be a viable first step. There would probably have to be some kind
of trade though because again, even many Democrats in the Senate don’t support Medicare for all. That’s not going to change in 2020 and it’s
unlikely to change in 2022 third and this is to me the most exciting. What about state single-payer? Vermont wanted to do this, but it ended up
failing for a variety of reasons that we could explore in a different segment. If Medicare for all succeeds at the state
level, a serious conversation about national Medicare for all would hopefully be able to
start Obamacare mirrored years later. In many ways, the Romney care system that
started here in Massachusetts, it falls way short of being what we want, but the point
is state level success can actually push nationally implementing some of these policies. So please don’t kill the messenger. This is not me attacking Medicare for all. I like Medicare for all. I want Medicare for all this is the reality. So that doesn’t mean that we now say, Hey,
you know what? If either way, the best we can get as a public
option or low lowering the eligibility age for Medicare a few years, you might as well
vote for Joe Biden. No, that’s not what I’m saying at all. What I am saying is that there are a lot of
people out there and they’re emailing me regularly who seem to be making arguments and decisions
based on the idea that if Bernie wins, we get Medicare for all in four years. That if Warren wins for the people that believe
she’s for Medicare for all, and she does seem to be, um, uh, then we get it within four
years. We just don’t, and I’m not being defeatist. Let’s strategize around what we can do. Let’s make it happen. And if you disagree with me, tell me where
I’m wrong on the facts. Not that I’m a shill or whatever. I want Medicare for all, but I need to be realistic about how we
get there.

The Complete Moderate’s Guide to Healthcare

A fake Youtube chef cut his hand in the kitchen…
this is what happened to his wallet. KB is a 25… ish year old Youtuber, presenting
to the emergency room – which was a huge financial mistake. This video was brought to you by CuriosityStream. My original plan for this video was to take
that scenario through multiple different healthcare paths to show you all the options and costs. I very quickly realized that wasn’t going
to work. Even if I had done that, those numbers would
have been completely meaningless to you because of how healthcare works in our country. It’s not like ordering a Big Mac. The numbers I would’ve given you would only
apply to other 25-ish year old men living in [HARM TO ONGOING MATTER], it’s very unlikely
that it would be relevant to you. So there’s really no point in digging up
those numbers. Especially since the cost of a procedure not
only varies widely within the same city, but sometimes on the same block. A few stitches can cost anywhere from $200
to $3000. I picked stitches because it’s pretty universal,
there is no gender, or race, or even class, that is more prone to needing stitches. I’ve personally needed stitches at least
five times that I can remember. The obvious explanation for that wide range
is where on the body were you injured? Stitches on your shin are going to be easier
and cheaper than stitches on your eye. Except… no, some people pay less for eye
stitches. And these price ranges exist across the board
for all procedures, if you walk into a medical facility with a burst appendix, it’s going
to cost you anywhere from $1500 to $180,000. I somehow doubt that one appendectomy could
be 120 times better than another. Some cases are complicated and require extra
imaging or post-operative care, the point is, you don’t know that beforehand. When you get the bill, it could be anywhere
in this range. So rather than just shouting numbers at you
and laughing about how ridiculous things can cost, I want to explain why that range exists. Many of you likely know parts of the answer
already. The most obvious being that urgent care is
almost always cheaper than emergency care. Both with and without insurance. Urgent cares are a relatively new concept
in the US and provide a cheaper alternative for non-life-threatening emergencies. Like stitches. Let me be clear, when in doubt, go to the
emergency room, you will never be turned away, but if you walk into an urgent care with something
more serious, they might send you to the ER, possibly delaying lifesaving treatment. But odds are that if you only need four stitches,
it probably isn’t going to kill you any time soon. Emergency rooms cost so much more because
of the infrastructure and overhead required to keep a large hospital running. But also because of more nefarious reasons. 70% of hospitals in the United States are
privately operated but not run for profit, which is surprising to most Americans. Insurance companies, on the other hand, are
only run for profit. So in order to attract more customers, insurance
companies have to offer better deals. Which is somewhat difficult when a hospital
is non-for-profit. Usually, if you’re not making a profit,
it means your prices are already as low as they can be. Enter the hospital chargemaster. That’s not a chargemaster. Pretend. Every hospital in America has a list of prices
for every good and service they provide, which until this year, was kept hidden from the
public. Which is a huge problem in a capitalist system. You can’t really make an informed economic
decision if there is no price transparency or easy way to compare different costs. Not that you would ever shop around during
an emergency anyway. So the insurance companies went to the hospitals
– Side note, in some cases, the insurance companies own the hospital outright, and while
the hospital is a non-profit… they aren’t. – and said “hey, you’re currently charging
your customers $200 for this service, why don’t you increase your chargemaster price
to $250, but still only charge our customers $200, that way we can tell them we’re getting
them a discount.” This should sound familiar to anyone who has
ever shopped on Black Friday. Repeat that for every procedure or medication,
nationwide, and you have the first piece of the puzzle. When figuring out the cost of healthcare in
the US, you have to look at multiple variables, we’ll add to this list as we go, but we
can start with the base cost. The price of materials, labor, facilities,
and sometimes including those blue light chargemaster rollbacks. As we’ve seen, this base cost can range
from three to six digits depending on where you go. Which is the second variable – location. Not only are we talking about state or city,
but street. Add in provider type – are you going to
an emergency room, urgent care, or just your doctor – and you have even more variation. Since we’re only five minutes in, you probably
figured out that this list isn’t even close to complete. An unfortunate reality of our system is that
it also matters who you are. The Affordable Care Act made it illegal for
hospitals and insurance companies to charge you differently based on your previous medical
history, but they can still charge you differently for basically any other reason – including
gender and perhaps most obviously, your age. For example, stitches on an infant are objectively
more difficult and therefore more expensive. Bet that wasn’t the direction you expected
me to take the ageism argument. Procedures aside, age is one of the biggest
factors that contribute to the cost of health insurance. Alright non-Americans, get your laughs out
of the way now. [Laughs in Foreigner] Health insurance started
as a sort of membership program, known as Health Assurance, you paid a fixed amount
every month and any medical costs you incur were on them. Your health was assured. It didn’t take them very long to figure
out the formula for success. Obvious abuses aside, that simple just model
wasn’t sustainable. So over time, they have shifted more of the
cost of actually using medical services onto the consumer, called it Insurance, and made
the system so complicated that most Americans don’t even bother trying to understand it. Lucky for you… I’m not doing anything, I’ve got time. The health insurance industry didn’t really
take off until World War 2, along with rationing fuel and rubber, prices and wages were also
fixed by the government. So companies had to get creative to attract
talent. The most popular way was to offer benefits
on top of your salary, like paid vacation, housing, or health insurance. Today, 60% of Americans get their health insurance
through their employer. This is thanks, in part to ObamaCare, officially
known as the Affordable Care Act or ACA, which made it so that any company with at least
50 employees has to offer health insurance. Though “offer” is a bit of a loose term. Which is yet another factor – how much your
employer offers to contribute. Your insurance premium might be $500 a month,
but your employer might only pay half of it… or none of it. In order to discuss how insurance actually
works, let’s take a look at something a little more simple – car insurance. In most states, if you own a car, you are
also required to have car insurance. The more people who are paying into insurance,
the lower the cost for everyone – most people accept this reality when it comes to car insurance. But not health insurance, for some reason. The Affordable Care Act did a lot of good
things, like mostly getting rid of pre-existing conditions, allowing you to remain on your
parents’ insurance until you’re 26, and a bunch of other stuff we’ll get to later. But it also required everyone to have health
insurance, through the Individual Mandate. The hope being that the more people who have
insurance, the cheaper it will be for everyone, just like car insurance. But the mandate was just repealed so, never
mind, I guess. Everyone with insurance pays a premium, this
is like your membership fee and you pay this regardless of whether or not you actually
use it. If your premium is $100 a month and you never
get into an accident, that $1200 a year is simply gone. Because of this, a lot of people think of
insurance as a bit of a scam – If I didn’t use it, I should get it back or something. This is what I’m going to call Stage Zero
– you pay your premiums, you don’t use it, and nothing happens. Rinse and repeat, every year. There are two tiers of car insurance, the
lowest being Liability, which only pays out if you are at fault in an accident, and Comprehensive,
which pays for any damage to your vehicle, whether it be a collision or an act of god. But once you actually have an accident, you
enter Stage One, when you pay all costs out of pocket until you reach your deductible. This is the amount you have to pay before
your insurance will contribute. For many car insurance plans, the deductible
is also your maximum out of pocket – or MOOP. Who the hell is Moop? It’s the most you will pay to fix your car
in a given year. After which, you enter Stage Two, when your
insurance pays all remaining costs. Sometimes, there is a maximum annual or lifetime
benefit, after which you would be on the hook for any remaining costs, but that’s fairly
rare. So if you get into an accident that costs
$15,000, you would only pay up to your deductible, say five hundred dollars, and your insurance
company would cover the rest. Congratulations, having car insurance probably
saved you thousands of dollars. But when it comes to health insurance, most
people only focus on the cost, if they never go to the doctor they’re just throwing away
money every month. This is important, so pay attention. Not having insurance is only cheaper, if you
know that healthcare costs without insurance will be less than your annual premium and
your deductible put together. Remember, without insurance, you will be paying
regular chargemaster prices. Some hospitals might be willing to work with
you and give you the “discount” price if you’re uninsured, but you can never count
on that. For our car insurance example, that tipping
point would be $1700. If you know that your car repair costs are
going to be less than $1700, it’s cheaper to just go without insurance. But you literally can’t know that. You can’t predict if some if some random
tire is going to hit you. Just as you can’t predict if you’re going
to cut yourself or your appendix is going to burst. So let’s say you’re playing it safe, you
have health insurance, and something unpredictable happens… Just like car insurance, you started in Stage
Zero. You’ve been paying your premiums and have
been relatively healthy until now. You go to the hospital and you enter Stage
One, you are paying everything out of pocket up to your deductible, so far everything is
pretty simple. But Stage Two is where things become a bit
more complicated – this is when you and the insurance company split the costs of your
care, through two mechanisms. A copay is a flat fee, like $25 every time
you go to the doctor. That’s just to walk in the door, by the
way, if they do anything more than that, it costs extra. Usually through coinsurance, which is a percentage
rather than a flat fee, so for example, 20% of all outpatient procedures. Only copays and coinsurance count towards
your MOOP, premiums, prescriptions, and out of network costs, do not. Once you hit your maximum, you enter Stage
Three – when your insurance company covers all remaining costs. The Affordable Care Act prohibits any maximum
annual benefit or lifetime limits for health insurance, though they can still exist for
dental and other insurance types. So Stage Three has no maximum dollar amount,
but your MOOP is annual limit that resets each year. This is the next variable we’re going to
add to our list – When the healthcare cost occurs. If your appendix bursts with only one month
left to go in the year and you hit your maximum out of pocket, if you still need continuing
care the next month – which is also technically the next year – you will have to pay your
maximum out of pocket again. Effectively doubling the cost of this single
event even with insurance. There are many different types of health insurance
programs, all of which cost different amounts based on what kind of care you want. Or more likely, what your employer chose for
you. The cheapest type is an HMO or Health Maintenance
Organization which operates through smaller networks of providers. Another very important term and concept. Doctors and hospitals sign agreements with
insurance companies to be part of their network and see their patients, sometimes at a reduced
rate, as I mentioned earlier. If you’re on that insurance, you can only
see those doctors and hospitals. If the doctor or the insurance company decide
they don’t want to work together anymore – you don’t get a say. If you like your doctor, or health plan, you
can keep your doctor. He couldn’t legally mandate that your doctor
and insurance company continue to work together forever – this is America. So now your doctor is out-of-network. If you see an out-of-network doctor, you will
very likely be on the hook for the entire, non-discounted bill. And you might not know it until afterwards. It’s not uncommon to go to an in-network
hospital and be seen by a prohibitively expensive out-of-network specialist at that hospital. HMOs typically have lower premiums up front,
but higher out of pocket expenses later. Everything is routed through your Primary
Care Provider, they make decisions about your health and you can’t see a specialist without
a referral or pre-authorization from your insurance company. That doctor acts as a gatekeeper for your
healthcare… which would make the insurance company the keymaster? The other end of the spectrum is a PPO or
Preferred Provider Organization, where you don’t have a primary care provider deciding
on what specialists you see or what care you receive. The premiums are higher but the out of pocket
expenses are lower. They typically have a larger network than
HMOs and out of network care is significantly cheaper, you don’t need a referral or pre-authorization. So it costs more to have more control and
more choice in your healthcare. That’s how capitalism works right? More choices and competition leads to higher-
wait… And then you have all sorts of programs in
between. Like the Exclusive Provider or EPO, which
is similar to a PPO, but out of network costs more and you might need pre-authorization
to see a specialist. Then there’s Point of Service, which is
like an HMO but out of network costs less and nobody abbreviates it. It’s a mess and even the definitions I just
gave you vary from company to company and state to state. But in general, those are your options, yet
another variable to add to the list. But wouldn’t it be great if we could just
cut out the middleman and pay for our own health care? Yeah, or you could- Shut up this is America. Some people have the option of getting a High
Deductible Health Plan or HDHP, which have extremely low premiums and extremely high
out of pocket costs. But it unlocks the ability to create a Health
Savings Account. An HSA is very similar to an IRA retirement
account, any money you pay into it is tax free and as long as you only use it to pay
for your insane healthcare costs, it doesn’t get taxed on the back end either. But wait, it gets better. Just like an IRA, you can invest your HSA
money, growing it potentially infinitely… which you also don’t have to pay taxes on. This is why they call them triple tax shelters. If you’re like me, you’re already googling
how you can open one of these up, and I’ve got some bad news for you. You can only open an HSA if you have an HDHP. If you’re on any other form of health insurance,
or even no insurance, this option is not available to you. And unless you’re perfectly healthy, that’s
probably a good thing. The astute amongst you will have noticed that
I haven’t given you any numbers for these programs… and there’s a reason for that. Not all HMOs and PPOs are created equal. Another good thing the Affordable Care Act
did was to establish a standardized tier system for health insurance, so people looking on
the marketplace can actually price compare and shop around. The absolute lowest level is called Catastrophic
insurance, these are typically your HDHPs, gamblers who are saving up their money and
hoping they never get sick or end up in a car accident. That’s about the only thing these plans
cover – emergency services. In America, all health insurance plans, regardless
of type or tier, cover emergency services in- or out-of-network. Though once you’re stable you better leave
that out-of-network hospital or the bill will give you a heart attack. Which just repeats the cycle. Catastrophic plans are like only having liability
insurance on your car, it really only helps you in the worst of situations, otherwise
you’re on your own. You also have to be under 30 to get it, which
means it doesn’t apply to me anymore so- I mean, it does apply to me for the next five
years. The four main tiers of the Affordable Care
Act are bronze, silver, gold, and platinum. The better the metal, the more you pay in
monthly premiums, but also, the lower your out of pocket costs when you actually receive
care. The ACA defines these tiers by the average
coinsurance for the plan, they call this the actuarial value. For Bronze, the actuarial value is 60%, they
pay an average of 60%, and you pay 40% in coinsurance. In Platinum, you pay 10% and they pay 90%. Again, this is the average, for some services
it might be 92% while others might be 85%. At the end of the year you might find that
you actually paid 11%. The actuarial value is the only definition
for the tiers – premiums, deductibles, and MOOPs can be all over the place. There’s really no way for me to compare
a Platinum HMO to a Silver PPO or a Bronze POS. Making this another determining factor in
your overall healthcare costs. But for the sake of an example, let’s just
pick one: gold. The average monthly premium for a gold-tier
plan is $597 a month for an individual and $1252 for a family. The beauty of family plans is that it usually
costs the same whether its two people or seven. If you’re getting a gold plan through your
employer, they might be paying for some of it. If you got it through the health insurance
marketplace, healthcare.gov, you might be getting subsidies to help. But for our purposes we’re just going to
stick to the base cost. So, let’s say you need those $3000 stitches. An individual gold-plan deductible can range
from $1000 to $5000, but the average is $1320. Remember, you pay that much before insurance
even kicks in. The remaining cost is shared between you and
the insurance company at a 20-80 split, only costing you an additional $336. The average individual gold plan MOOP is $5878,
so we’re not even coming close to stage three. In the end, those $3000 stitches cost only
$1656, just over half, wow, it’s a good thing you had insurance… You forgot ab-
Son of- yeah, as most people do, I forgot about the premiums. On top of the stitches, you paid $7164 in
premiums, bringing your total health care costs for the year to $8820. Here’s the same scenario for the average
gold family plan. As I’ve said, it’s impossible to know
whether an uninsured person with the same $3000 injury would fair better financially… But it is possible. And while the person writing the $1600 check
while paying monthly premiums is going to feel a lot more financially secure than the
person cutting $3000… The economic realities of healthcare costs
in America don’t care about your feelings. Now, I picked gold as an example because it
has an actuarial value of 80%. Which is the exact same as Medicare. Medicare is a socialized health insurance
program that covers 59.9 million Americans, most of which are over the age of 65. It is the largest single provider of health
insurance in America. I briefly covered Medicare and how it’s
funded in my video on welfare, along with another program for poor people called Medicaid. Medicaid is run at the state-level. So while it covers 74 million people, they’re
spread across 54 different state and territory programs that all set their own requirements
and pay outs. A single person in Alabama must make less
than $771 a month to qualify for Medicaid. The average panhandler makes $25 a day begging
for money on the corner – if they’re out there every day this month… Maybe take Halloween off, is all I’m trying
to say. Medicaid benefits depend on your income level,
at the lowest you’re paying single digit copays and at the highest, 20% coinsurance. Just like Medicare. But while Medicaid is a complicated welfare
program, Medicare is not. It’s government-subsidized health insurance. Every American who works pays into it with
a 1.45% FICA tax, which is also matched by your employer. If you contribute for ten years, you get full
Medicare when you turn 65. Medicare is not free, it’s also not simple
– but since it currently covers 20% of all Americans and presumably will cover all of
us once we’re old enough, it’s worth looking into. I need to start by saying that this is just
an overview. Most of my audience is several decades away
from Medicare, so if you’re currently in the process of enrolling, please speak to
a professional, this is just an introduction. There are entire channels dedicated to explaining
Medicare – we’re just going to scratch the surface. Medicare has four parts. Part A is for inpatient services like overnight
stays at a hospital. For the vast majority of people, there are
no premiums for Part A. But there is a $1364 deductible and a complicated copay and coinsurance
table. Medicare Part B is for outpatient services
like regular doctor visits. This does have a monthly premium for most
people, but before I tell you what it is, remember that you’re getting an actuarial
value of 80%. $135.50 a month – regardless of who you
are. But we’ve learned that low premiums usually
equate to a high deductible so- $185 deductible. So because stitches are usually an outpatient
procedure, we can figure out that those $3000 stitches would cost you $748 out of pocket. And $2374 a year in total expenses. There are no family plans in Medicare, it’s
just for the individual retiree, and these are by far the cheapest stitches we’ve come
across so far. But there is a catch. Medicare Part A and Part B, collectively referred
to as Original Medicare, have no maximum out of pocket limit. You pay the same 20% coinsurance to infinity
and beyond. Which is why we need to talk about Medicare
Supplement Plans, also known as Medigap plans. These add a MOOP, as well as reducing your
coinsurance. This is an addon run by a private insurance
company that doesn’t get to decide what or how much they cover, that’s dictated
by Medicare. They do get to decide what to charge you though. Alternatively, you can scrap Original Medicare
altogether and opt for Part C – better known as Medicare Advantage. This is a private insurance plan that takes
the place of Parts A and B (and sometimes D) and acts as its own supplement, so you
get a MOOP. You pay your premiums to them, rather than
Medicare. Now the insurance company gets to make decisions
about your healthcare, instead of the government. And it is required to give you that same 80%
actuarial value… in theory. In practice, the HHS Inspector General recently
found that 56% of people on Medicare Advantage were denied necessary treatment simply for
monetary gain. I know, right? I was just as shocked as you. About 36% of people eligible for Medicare
opt for Medicare Advantage, so when you hear someone complaining about Medicare… There’s a decent chance they’re not actually
on Medicare. And I’ll give you one guess as to which
Part ends up with the most waste, fraud, and abuse… It’s actually Part D, which is your optional
prescription drug coverage – but before you get mad at me for the bait and switch,
both C and D are run by private insurance companies. I’m not kidding, Part C and D waste, fraud,
and abuse is rampant, you can find the powerpoint presentations from HHS online. The problem is that when the news tells you
about Medicare waste, they usually leave out which Parts are causing that. And when they talk about healthcare statistics,
they neglect to mention that a third of the people are actually on private insurance. The 59.9 million number I cited earlier is
Original Medicare and Medicare Advantage put together. There are 44 million people on just Original
Medicare. And 90% of them don’t use Medicare exclusively,
they get a Medigap supplement plan or a Part D Prescription plan, or both. Prescriptions aren’t usually covered by
health insurance. Even in countries with universal socialized
medicine, dental, vision, and prescriptions are usually separate. And prescriptions drugs are even more of a
mess than healthcare. Each Part D plan has a list of prescriptions
they cover called a Formulary, you’ll need to look over that list when choosing your
plan. I hope you accurately predicted what medicines
you’ll need in the future. Americans pay the absolute highest prices
in the world for medications, sometimes by an order of magnitude, and the main reason
is somewhat counterintuitive. The UK has a single payer system known as
the National Health Service or NHS, every British citizen is covered for almost no out
of pocket cost. A total of 66 million people. The government negotiates prices with drug
companies, knowing that they will be the only supplier of that medication to 66 million
people. So they get a pretty good deal. There is no equivalent in the US, the government
doesn’t negotiate or even really regulate prices – the best we have is Medicare with
44 million people. And there’s a reason they pay the least. Counter to the common capitalist perception
that competition and choice drive down prices – at least when it comes to healthcare – market
share seems to have much more influence. The more people you are negotiating on behalf
of, the lower your prices. But also, it costs a lot of money to develop
treatments and medications, so most companies want to make the largest return on investment
as they can. But when you’re selling to the UK and Germany
for such low prices, where are you going to make your money? The country that isn’t negotiating on behalf
of 320 million people and has little to no regulation regarding price ceilings. Why do they charge so much? Because they can. The common argument against adopting a system
like the UK is that they are incredibly overtaxed. So let’s get our calculators back out and
check. The median household income in the United
States is $59,039, assuming just the standard deductions for a single person, you would
be paying $10,804 in federal taxes – both income and FICA. I have a video all about income taxes if you
want to know the actual math behind that. If you took that same income and went to the
UK, after converting to pounds and then back again, you are paying $14,451 in national
taxes. This includes your income tax and the National
Insurance tax, which is like our Medicare tax but, significantly larger. Side by side, if you make the median household
income in the US, you are paying 18.3% in federal taxes, if you took that to the UK,
you’d be paying 24.5%… but remember, healthcare is included. If you want healthcare in the US, the average
annual employer-based premium across all types and levels for an individual is $6896 a year. So in reality, you’re paying 30% of your
income in taxes and health insurance – and that’s not even considering what happens
if you actually get sick. In the interest of being thorough, if you
double the median income to $118,078 and were married with two kids – you would be paying
significantly more taxes in the UK. However, your healthcare expenses don’t
really change, whereas the average employer-based health insurance premium for a family is over
triple that of an individual. So a US family is still paying more in taxes
and healthcare – even if they never go to the doctor. The UK does have a Value-Added Tax, or VAT,
of 20%. But their cost of living is about 7% lower,
so once you consider sales tax in the US, prices are pretty comparable. A Samsung Galaxy S10 costs about $15 more
in London than New York. And a Big Mac is a dollar fifty cheaper. The quality of these products are pretty much
the same wherever you go, but for some reason, we insist that US healthcare is the exception. That has to be the last variable on our list,
American stitches are just inherently better than UK stitches. No, most people already know this, but the
UK, Canada, Australia, and most other industrialized countries beat us in just about every healthcare
metric. Life expectancy, infant mortality, maternal
mortality, the list goes on. But generally, these numbers are close enough
that you can say that the US is basically on par with everyone else. But per capita, we’re paying double what
they are. Objectively, the UK does have longer wait
times, from a few more minutes in the ER to a week or two for a specialist. But I want to challenge your assumptions here. If waiting a little longer drastically reduces
cost, but doesn’t negatively impact healthcare outcomes… How important is it to be seen right now? Can you zoom in and say the US is better in
a specific field like heart transplants or post-op complications? Sure, but overall, we’re not getting what
we’re paying for. Which is why we’ve been arguing about how
to change this system since forever. But we might actually do it this time. I’m obviously not going to talk about all
of the proposals, because you’ll never hear from most of these people ever again. So let’s just focus on two. Mayor Pete is proposing a Medicare opt-in
plan or “Medicare for all who want it.” This is just a reskin of the classic “Public
Option.” This would open up Medicare to anyone, if
you’re uninsured, you’re automatically on it, if you get health insurance through
your employer, you can switch, but otherwise nothing changes. Unless your employer wants to switch to Medicare,
in which case you don’t have a choice. It would also make a few smaller changes like
adding a Medicare MOOP and capping out-of-network costs. Most people wouldn’t see any changes to
their healthcare. Which isn’t very exciting, so let’s talk
about the plan you all want me to – the Medicare for All proposal from Kristen Gillibrand. She’s not even running anymore. You won’t let me just have- Fine, let’s
talk about Bernie Sanders. Bernie’s Medicare for All plan would basically
turn our healthcare system into the UK’s, with a single payer government health service. But with dental, vision, and prescriptions
included. Like the UK, there would be no premiums and
little to no out of pocket expenses. It also abolishes private insurance. No more employer-based health plans, no healthcare
marketplace, no deductibles, no premiums, no channels completely dedicated to demystifying
Medicare. You and your doctor will make decisions about
your healthcare, not a private corporation. Instead, the government would be the third-party
payer. How they would pay for this is always a point
of contention and oftentimes the question is intentionally worded poorly. How much are your taxes going to go up? And you said… How much are your costs going to go down? No, different question, how much will your
taxes go up? No, it’s how much are your costs, because
it’s- This sounds like a dodge because she’s trying
to reframe the question. Taxes will go up, primarily for the wealthy,
but likely the middle class as well. But remember, even if your taxes went up by
50%, the fact that this expense no longer exists means you are still better off – and
you won’t pay much more, if at all, when you need medical care. This would also reduce the overall bloat in
our system that contributes to the high cost. Your HR person has to pick a health plan,
hospitals and doctors need to hire special billing coders, the insurance company needs
claims specialists, and youtubers need to make videos explaining it all. I’m positive we can do better than this. But if you insist on keeping your healthcare
expenses unnecessarily high, even under the proposed Medicare for All, might I suggest
getting into vitamins and supplements? An industry you can learn all about by going
to curiositystream.com/knowingbetter. CuriosityStream is a subscription streaming
service that offers over 2400 documentaries and nonfiction titles from some of the world’s
best filmmakers that you can access across multiple platforms. Learn all about vitamins and the industry
that sprung up around them in this documentary hosted by fellow youtuber, Veritasium. Even though I know most of us don’t really
need to take vitamins, I can’t seem to help myself. You can get access to their entire library
for as little as 2.99 a month, but if you head over to curiositystream.com/knowingbetter
and use the promo code knowingbetter, you can have the advantage of getting your first
month completely free. As well as getting access to Nebula, the new
streaming service put together by youtube creators to have a space to create videos
without worrying about algorithms and demonetization. My channel, as well as many of your other
favorites, can be found there, including several original series. By joining CuriosityStream and Nebula, you’ll
also be supporting the channel. Full disclosure, I have no horse in this race. I am a service-connected, disabled combat
veteran, I get my healthcare through the Veteran’s Affairs hospital – which isn’t a health
insurance program. It’s a self-contained system and a bottomless
well of asterisks. So I’m not complaining about the system
and talking about proposals for change for my personal benefit. I also had no reason to give myself all that
math homework. It took me a month of daily research to figure
all of this out and present it to you and that alone should tell you this is overly
complicated. Luckily, I don’t do anything else with my
time. So now, as you’re watching debates about
taxes and reading news articles about rising premiums, you’ll actually understand what
they’re talking about, because now, you know better. If you hadn’t noticed, I made some improvements
to the set, so if you’d like to add your name to the chargemaster, head on over to
patreon.com/knowingbetter, or for a one-time donation, paypal.me/knowingbetter. Don’t forget to copay that subscribe button,
check out the merch at knowingbetter.tv, follow me on Twitter and Facebook, and join us on
the subreddit.

My INSANE Health Insurance Plan

So I’m still collecting invoices from my October
2nd appendectomy. So far they total about 6,500 under dollars, but I’m still waiting for what’s
called the facility fee, which includes the operating room, the anesthesia, the volume,
the staples that they use. You know all of that stuff. So when I have it all, I’m going to come to
you with a full detailed accounting for my appendectomy. But I do now have the proposed changes to
my health insurance plan if I keep the same plan going into 2020 and I think this will
be really informative because it’s going to actually expose the disgustingly broken nature
of how our healthcare system and health insurance system is fundamentally organized at a base
level and should really sound the alarm as it’s obviously, it’s not just me who sounding
the alarm, but this will once again sound the alarm is another data point for why the
system needs to change. So I live in Massachusetts, Massachusetts
considered to be one of the better places to be thanks to Romney care, sort of precursor
to Obamacare when it comes to health insurance. A very close to total health coverage here
in Massachusetts. Mass health is a program that is very popular
for people who have it on the basis of their income. Since I have my own business, um, and I exceed
the income limits for a subsidized plan or a mass health plan, I just buy my plan through
something called the Massachusetts health connector. I, it’s unsubsidized, it’s just, it’s a market
for people who are self employed or whose job does not offer health insurance. So I just pay for the plan. Now I chose what’s called a silver plan. They go bronze, silver, gold. I think there were still platinum plans, although
I’m not sure. Of course the higher you go, the more you
pay monthly, but the less you pay when you need things done. Silver for me seemed sort of like the right
balance between the monthly premium and how much I have to spend when I actually get care
of different kind. So in 2019 my plan costs $421 per month. That’s what I pay out of pocket. So let’s dig into how my plan will change
between 2019 and 2020 I was just notified of this if I stick with the same plan. So for starters, my premium goes from four
21 to four 58 okay. An extra $37 a month. That’s about a 9% increase in what I pay for
the premium. But the plan also gets worse in terms of what
will be covered. So my annual deductible stays the same. It’s $2,000 for my appendectomy, for example. It like I’m going to owe my full $2,000 deductible. Of course, in addition to the $421 monthly
payments that I’m making, my plans out of pocket maximum is going up from $6,500 this
year to $8,150 in 2020 so the out of pocket maximum is the most you would have to pay
for all covered services in a plan year. So my deductible’s 2000 imagine that I have
three or four instances, uh, medical events where I pay the $2,000 deductible this year. Once I’ve paid 6,500 total, my insurance would
cover everything next year. That limit is being raised to 81 50 okay. My primary care poke copay is going from $30
to $50. Remember my premiums going up as well, and
in addition it will cover less. My primary care copay going from 30 to $50. My specialist copay going from 50 to $70. If I go to a dermatologist, for example, or
a podiatrist, as many of you know, I went to back in June, that’s still not resolved
by the way, my urgent care copay, you might remember earlier in the day of my appendicitis,
I went to urgent care. I had a $55 copay. That copay goes up to 70 next year for blood
work and imaging like x-rays. This year I had a $50 copay after my $2,000
deductible was met. Next year it’s going up to $75 per instance. After my deductible is met, emergency room,
uh, this year my deductible is 350 my copays, $300. Next year it goes up to three 50 of course
after the deductible is met. So I am going to be paying, if I want to keep
this plan an extra $37 a month, that will make my yearly premium $5,500 and then I still
have to hit a $2,000 deductible for lots of things and to have even higher copays in other
areas like primary care specialists, urgent care and in the emergency room. I want to go back, I think I might have misstated,
uh, the 81 50 annual limit is the deductible of 2000 plus additional copays and everything
else. It is not multiple deductibles. I, I may have been unclear about that and
I apologize. So this is considered good insurance in the
individual market and Massachusetts is considered a good place to be. This is insane. The system has to change and we’re going to
go into this in more detail when I spell out the appendectomy costs that I incurred last
month. But part of what makes this not work, part
of what makes this system the wrong one is that there is completely inelastic demand
for a great portion of healthcare services using appendectomy. As an example, if I don’t have appendicitis,
my demand for appendectomies is zero. It’s not like with many other consumer products. If appendectomies are 10,000 thousand dollars
I don’t want one. If the appendectomy is $5,000 I sort of want
one at $1,000 I really want one and at a dollar I would want multiple appendectomies. I might as well take advantage because that’s
such a good deal. No, that’s not how it works, but then once
you have appendicitis, your demand is also not affected by the price. If you have appendicitis, I can testify to
this. If the appendectomy costs a dollar or $1,000
or $100,000 you need it and you need it right away and your demand for it is not impacted
by the price. Compare this to, for example, a Tesla. If a Tesla costs $100,000 it might be totally
out of your price range. Your demand is effectively zero at $50,000
it’s a big stretch, but you’re certainly more interested in it than at $100,000 if the Tesla
is $15,000 now you’re very interested. If the Tesla is 100 bucks, you want to buy
a whole bunch of Teslas. Potentially. That’s not how healthcare, how healthcare
works and that is why the system we have is a moral, and I was trying to explain this
the other day on a live Twitch stream where we have a lot of international viewers and
they kept saying, wait David, you’re, you’re saying you pay four 21 a month and you still
owe two grand for your appendectomy? Yes, I pay four 21 a month for the privilege
of limiting what I owe for my appendectomy to $2,000 rather than the eight or nine or
$10,000 that it will probably end up costing in total. This is a big piece of the immorality of the
profit, the for profit healthcare system that we have. We will talk about it more upcoming and I
will get you those. A appendectomy figures once I have them.

If Bernie Wins, How Does Medicare for All Happen?

Let’s see what’s on people’s minds today. We will go to the phone lines at (617) 830-4750
and we will start today with our color from the seven seven zero area code color from
seven, seven zero. Uh, what’s your name? Where are you calling from? [inaudible] seven seven zero. I heard you shuffle Richard’s enough. Kaylon where are you David? Hey Richard. What’s going on? Hello? Yes. What’s going on? Richard? [inaudible] okay. Again here. I’m good. Hey. So here’s my question. Um, so with this, let’s say Senator Sanders,
um, somehow is able to actually win the nomination and does end up wanting the presidential race. What do you think the odds are that you will
actually get a Medicare for all bill pass? Because it seems like even those who do support
Medicare for all have some watered down version of it. Like, so how many do you think would actually
vote for it if it were to be put put on the bill for everyone to vote on? This is a very important question, which is
that even within the democratic party, there is not, um, sort of unanimous consent around
number one. Not everybody in the democratic party supports
Medicare for all. And even those that support something that
they call Medicare for all, they don’t necessarily support it in the exact way in formulation
that Bernie Sanders does. But I don’t think that this is particularly
relevant because what we’ve seen is that the more, um, uh, progressive position that you
start the negotiation from, the better off we will end up. So Bernie Sanders can’t control whether Democrats
take control of the Senate in 2020 or 2022. Bernie Sanders can’t, at least not directly
control, uh, what the majority of the democratic majority is in the house or whether they maintain
one after the midterm. All he can do is say, here’s my starting point. And then he will negotiate with whoever is
there for the most progressive possible plan. So I think you’re bringing up a perfectly
reasonable question, which is, is it guaranteed that a president Bernie gets Medicare for
all? The answer is definitely not. Definitely not. And this is just a reality. I mean, it’s not a pro or anti Bernie bias
thing, it’s just, there’s no guarantee that any president gets done what they want to
do. The more audacious it is, the more difficult
it will be to do. But we still want to be starting from the
best possible place. Right. I do have one more follow up if you have time. It’d be a quick question. Um, so one of the main arguments I hear against
Medicare for all courses, how are you going to pay for it and whatever. Someone brings up Canada, UK off from the,
the number one, uh, pivot from, from the right six of you. Well, but there, you know, population is significantly
less than I was. That’s right. They’re able to, you know, have a system like
that. So run on how to care for all at a state level
instead of a national level would actually be any better. Um, just be [inaudible] it seems like it would
be a little easier to manage, or at least it’s the way I see it right now. So I dealt with this earlier this week, so
I won’t, I won’t do the full explanation, but, so two things on that. Number one, I disagree with the premise that
if you have more people, it’s more difficult to do because more people actually means that
the, the risk pool is larger and no one group within that population is going to throw off
your actuarial predictions, um, nearly as much. So I reject that on principle. That being said, I have no problem with Medicare
for all or other single payer systems starting at the state level. I think that from a pragmatic perspective,
you might much more quickly be able to get something done. So I’m not opposed to it in any way, but the
population argument is a tired one. [inaudible] gotcha. Thank you David. Appreciate the time. All right, Richard. Yep. Gonna let you go. Uh, thank you for the call.