 The David Feldman radio program is made possible by listeners like you. You sad pathetic humps This is a bonus episode of the David Feldman show on healthcare We're prepping a show for Tuesday about health care in America and while we were getting the show ready We came across an episode from July 29th 2013 entitled Obama care isn't enough. I am I know you are devastated by what the house pulled off last week and We have to stop it in the Senate and we're prepping a show for Tuesday about health care in America And we decided to run as a bonus episode from the vault Obamacare isn't enough on the show recorded back in 2013 Four years ago Dr. Paul Song and Dr. Nancy Naparco from Physicians for a National Health Program Explain why America needs a single-payer health care system right now Everything you need to know about Obamacare is in this episode Also, everything you need to know as to why Obamacare isn't enough to heal all Americans Physicians for a national health program is a nonprofit research and education organization of 18,000 physicians medical students and health professionals who support single-payer national health insurance This show is about national health insurance universal single-payer national health insurance Medicare for all for more information. Please visit www.pnhp.org Also on this episode my good friends Mark Thompson and Music from Will Ryan and the cactus county cowboys. Please enjoy this special episode from our vault Welcome to the broadcast. I'm David Feldman David Feldman show calm Please friend me on Facebook follow me on Twitter and don't forget to subscribe to this show as a podcast for free on iTunes on today's program Everything you need to know about Obamacare and why it simply isn't enough to heal all Americans On today's show everything you need to know about Obamacare and why it simply isn't enough to heal all Americans past in 2010 ruled constitutional by our Supreme Court in 2012 Obamacare in the next three years will be rolled out in its entirety With health care exchanges the individual mandate and the recently delayed employer mandate But what does this mean for you? Health care is like cancer or heart disease We don't want to think about it until it happens to us Unfortunately, just like cancer and heart disease Sometimes it's too late to think about it Trillions of dollars are earned every year making us sick and then healing us and It isn't the best interests of the individuals who get rich off of health care to make health insurance so Complicated you just throw up your hands and surrender to whatever your insurance provider is willing to give you Obamacare is a start, but it's not enough On today's show we will meet two physicians representing physicians for a national health program www.pnhp.org Physicians for a national health program is a non-profit research and education organization of 18,000 doctors medical students and health care professionals who support a single payer national health insurance system here in America www.pnhp.org Today they will patiently walk us through Obamacare and show us why America needs to join the rest of the industrialized world And evolve into some sort of single payer system healthcare in America stinks We lag the industrialized world in everything when it comes to health care except one thing spending Because we have been Infatilized by the media doing corporate America's bidding we choose not to understand how exactly Health insurance works like I said until it's too late One of the primary missions of this program is this To teach you especially young people that we are not stupid That we are being made to feel stupid by the people who want us to be confused Who want us to remain in the dark so they can continue to make? trillions of dollars On today's show. I talked with two brilliant physicians representing Physicians for a national health program www.pnhp.org And near the end of today's show I asked them a very simple question I asked what is harder for you to get your arms around Organic chemistry or understanding how our health insurance system works Immediately they both agreed that our health insurance system here in America was harder for them to understand Than organic chemistry Now if our brightest Americans don't understand our health insurance system There's a reason for that On today's show you will learn the difference between single-payer and socialized medicine the difference between Medicare and Medicaid and how exactly Obamacare works and why it isn't enough You will learn why it's important for all of us to go to www.pnhp.org every day and join Our physicians and their fight to bring medicine to all Americans because healthcare is not a privilege. It is a human right America you need to be angry and we need to fight The government is right There is a terrorist among us But it's not Al Qaeda. It's the health insurance sector We need to put well-point and their ilk out of business Osama bin Laden could only dream of killing as many Americans as well-point and their ilk have This is the fight of and for our lives We need to get angry we need single-payer, but first we need the one thing. They don't want us to have the facts Healthcare in America is a disgrace for two simple reasons Their greed and our ignorance We can't change how greedy they are, but we can change our ignorance www.pnhp.org Physicians for a national health program this morning. We're doing the heavy lifting grab a cup of coffee Everything you need to know about Obamacare and why it's simply not enough But first new music from Will Ryan and the cactus County Cowboys I wouldn't wish on you The things it puts me through that aggravate Irritating song that won't leave me alone. It just won't stay away It haunts me night and day that Aggravate and irritate and song that won't leave me alone Every morning I rise and whoa, whoa, there it is I barely open my eyes and whoa, whoa, there it is And now it's no surprise But whoa, whoa, there it is that never do that's haunting me All day long the same old song then sleeping as I dream I hear that crazy theme That aggravate Irritating song that won't leave me alone Every morning I rise and whoa, whoa, there it is My eyes and whoa, whoa, there it is by now. It's no surprise that whoa, whoa There it is that melody that's haunting me all day long the same It's on the end sleeping as I dream. I hear that crazy thing Aggravate and irritate this song that won't leave me alone That aggravate and irritate and song that won't leave me alone That aggravate Irritate this song that won't leave me alone Joining us is Will Ryan. Howdy, Davey. I understand you have a song for us today Yes, and probably we just heard it Dr. Paul song is with us. Oh, that's that's right I do Dr. Paul song is right here and Dr. Nancy Noparco, did I pronounce that correctly? That's right. Hi, David. I think I know you you got to talk closer to the microphone Hello, and Mark Thompson a doctor Mark Thompson, please David. You have a doctor in meteorology I'm I have a doctor a lot of things. I mean depending on another formal degree, but people call me the doctor Okay, I have a doctor doctorate to in pseudo science not just ordinary science So we are coming up on a 48th anniversary of Medicare and to commemorate the birth of socialism in America Dr. Nancy will be moderating a discussion at the historic arrow theater in Santa Monica 1328 Montana Avenue in Santa Monica, California August 1st 2013 at 7 30 p.m And one of the featured speakers will be dr. Paul song Who is an oncologist and both of you represent PNHP Apparently the two of you are not happy with obama care. You Want a single payer system? and you will be Moderating a discussion Nancy dr. Nancy about this as well as showing the health care movie narrated by kiefer sutherland Who I believe is the grandson? Of the man who gave canadians universal health insurance. Is that correct? Yes, tommy douglas Who is the father of universal health care in canada? That was his grandfather His grandfather was tommy douglas tommy douglas and that got passed what in the 60s It was well completely implemented in the early 70s initially started on a province basis In scat a scatch one and then kind of spread like wildfire after that And that's sort of the model that we hope to duplicate here in the united states Trying to get everything done through congress is going to be pretty difficult Especially with the dysfunction that exists there But if we could pass it such an estate like california And then perhaps people would see that it really works then implemented on a state-by-state basis right and just so I know the universal health insurance in canada was passed in the 60s Using a plan that was developed for america if i'm not mistaken Well, the the idea was that it was initially called medicare as well like ours was Except instead of just doing it for seniors or disabled people it was for the entire population So they took it one step further So yes, it was originally an idea that was really set forward multiple times in the united states harry truman Did on numerous occasions, but we just never had the political appetite or will to get that done here And you are not opposed to obama care. I would assume you think it's the first step towards a single payer system Absolutely, I think that we have to look at a lot of the good things that exist in in the affordable care act But it doesn't do nearly what we As a society need first and foremost people think that it's universal It's not before the affordable care act fully goes into implementation There's roughly 51 52 million americans in the united states that are uninsured The affordable care act prior to the medicaid supreme court ruling was only designed to ensure about 32 million of those people 16 million of those people were going to be get coverage through the individual mandate Which is really only five percent of our whole country, but yet everyone thinks the individual mandates This massive hand of the government coming down on everyone But it's only five percent the remaining 16 million were supposed to be covered by the expansion of medicaid So in its best situation 32 million out of the 51 million would be insured The problem was that now with the supreme court telling certain states you don't need to accept medicaid It's actually going to be less all the undocumented are not covered And so when it's all said and done the feeling is that we may have still 30 million uninsured by 2022 So it's almost like whack-a-mole. You're starting to solve some problems But you're still having a huge amount of people that are uninsured Which are going to continue to drive everyone's cost up in the next two years We're going to see the fruition of obama care. Basically. I guess they the employer mandate Has been pushed back a year, but tell us the good What is the good that's about to happen or has been happening from obama care before we talk about how it Falls short in so many ways. I think the the the good things are actually the things that have been implemented already So people on kids under the age of 26 can stay on their parents plan No recisions, which means an insurance company cannot all of a sudden pull your care from out underneath you When you get sick because of some quote Questionable reporting that you did on your application or they come up with a million reasons There's no lifetime cap on what an insurance plan will pay for your coverage What do you mean no lifetime? So let's say you some you're somebody who had chronic medical problems You might have been born with a rare genetic disorder that Caused you to require a transplant and after the transplant you developed all of these other subsequent problems Most insurance plans had a lifetime cap So if you had a lot of illnesses, let's say somebody is a child who's born with something and has multiple surgeries By their time they're in their 20s. They've already exceeded that. Let's say it's about a million dollars So any additional expense that they have moving forward. They wouldn't be covered by their insurance plan No, I didn't realize it That's interesting and then who would end up paying for that Well, most of the time people would go bankrupt or the government would have to pay for that because the uh They would be quote uninsurable at that point So as a result one of the good things if you say the government Medicaid Medicaid would have to cover somebody like that because their private insurance met their maximum sort of responsibility So one of the things that's happening with this is there's no longer any lifetime cap So if you or I get sick and we continue to get sick That insurance plan will have to take care of us for for whatever Or at least until we're 65 and they'll probably try to kick us off into Medicare at that particular time If we're lucky to live that long. So that's a really really really great The second thing is existing conditions. No pre-existing So now if you have had a heart attack and you switch jobs and you were Given one insurance plan through one employer, but now you have a new job That uh insurance coverage cannot deny Covering you because of your pre-existing condition. You're an oncologist. Correct if you're treating Somebody I've been glib here and I apologize If you're treating I'm not going to make a joke You're going to make some crack about me, weren't you? No, no If you're treating somebody my two defensive doctor, do you think I either doctor? When did the pre-existing Condition factor kick in is it is that in now to insurance companies have to yes So that all of those things uh, so every minute so the the the individual mandate the exchanges that's what's coming up in 2014 okay, so in 2014 president obama signed the original Bill two years ago all of those immediate things. So no recisions. No lifetime caps No pre-existing conditions. You can stay on your parents plan till you're 26 The other thing is seniors who are in medicare for preventable preventative care checkups and exams That's all now covered by the affordable care act Those are the the real positive things that I think both republicans and democrats can agree on That were things that we really needed were the things that were implemented republicans Will not agree on that they're all if it was yeah, exactly if it if it was um proposed by the heritage foundation or bob dole or any of the other people that had Proposes in the past mit romney It would have passed in a heartbeat. That's the thing that I always say That we didn't get a democratic plan. We've got a rehashed Uh from the heritage foundation exactly So if you have terminal cancer And you were one of the people who didn't have health insurance You could go to blue cross and they would have to give you health insurance Yes, but the the tricky part is that doesn't mean you could afford what blue cross would cover so up until 2014 Most states and this has been covered by the federal government have set up catastrophic insurance for people such as Okay, you're going a little too quickly because i'm only a human being and I I know how brilliant you are right mark and I were following it Yeah, I didn't make I didn't have a problem actually but go ahead right now right right now in 20 again What year is this doctor 2013 very good. We do have it slowly Uh-huh Right now or last year if you had terminal cancer And you wanted insurance for the first time could blue cross charge you an exorbitant Yes, and then what happens two years from now does that so up and so let's just deal with right now For somebody who has cancer who wasn't who didn't have insurance You know, you're you're uninsured you get diagnosed and now you want to try to go get it You could conceivably get it through blue cross because they cannot deny you for a pre-existing condition However, the they probably would charge an exorbitant fee that you probably couldn't afford it. Okay What the government has done until the exchanges are fully up and running Which is the competitive marketplace is they've given states money to set up a Catastrophic plan for people such as that matter of fact the la times I think it was about a year ago Illustrated somebody who lived in the valley who came down with The exact same scenario breast cancer uninsured Was unable to get coverage at that point that she could afford But through the federal subsidy that is currently there until the Larger exchanges set up in california. She was able to purchase insurance So the federal government is picking up the slack until the states Agree to set up these exchanges A majority of states are controlled by republicans correct with Governors and legislatures that are all republican Many of whom are saying they're not going to set up these exchanges So the federal government steps in If the republican states refuse to set up these exchanges won't that lead eventually to single payer if Haven't I read somewhere that the republicans are really shooting themselves in the foot by not setting up these Exchanges because people will turn to the federal government and we will have a de facto single payer I wish it was that easy and um, so do I I don't know if that will fully happen I think the rationale or the thinking behind that argument was that The affordable care act is truly still the closest thing to a free market health care system You know, it's a big subsidy to the private insurance industry Which is a still a private for-profit insurance industry that only makes money by denying you and I care There's still the entrusted gatekeepers of this big affordable care act. It's not socialized medicine. It's not the government So the feeling was that if these republican governors really stand in the way and cause it to just collapse Or the other hand is that Insurance rates continue to rise for the rest of us who have insurance that there'll be such disdain and such Anger towards the existing system that people will call for something much more aggressive by the government That is some feeling behind it. I don't necessarily think that Or there's been also other editorials that this deliberate undermining By the republicans not only in terms of not setting up the exchange But now they've just I don't know if you heard they lobbied the nfl Not to Help enroll people in the affordable care act The marketing campaign that the nfl was trying to write There was essentially just using the ballplayers to help explain certain aspects of the new plan Whenever I need medical advice. I always turn to the nfl What's the latest from people who've suffered massive concussions? I need medical advice from them But this deliberate undermining I think is actually going to come back in some ways and shoot themselves in the foot I think that particularly in the states Like louisiana and texas that have huge huge uninsured populations that could have truly benefited from the medicaid expansion At some point people are going to realize These people do not have our interest at hand regardless of ideology. They haven't gotten hip to that yet Same but for our listeners overseas and believe it or not here in america more likely here in america than overseas What is medicaid versus medicare who set up medicaid so medicaid Came slightly after medicare medicare was launched in 1965, which was a great year the same year. I was born I'm actually two weeks older than medicare And that was really designed for seniors and disabled and the feeling was back in 1965 or prior to that 51 of all people over the age of 65 were uninsured Because most people got their health coverage through their employer and once they retired there was no safety net for them And one out of every three seniors was also living in poverty And why was that because most of them as they got older? They were spending a lot of money on medications and doctor fees and all those things And it was really part of the great society with Lyndon johnson and really was initially shepherded by truman I think truman was really the first person to try to do this So that was medicare Medicaid was then started afterwards for low income Poor people that were under the age of 65. What year would that be roughly? I think it was just a couple a couple years later. Maybe 1967 or 68 I don't have that off hand and they we can't expect them to know everything. It was only two years old at the time And Medicaid Relyed on the states whereas medicare Really is more of a federal federal government big big government and medicare is you depend on Block grants right each individual state to administer it any way they see fit So medicare is we all pay into the system with our payroll taxes and that money goes into fund medicare Whereas for if you're poor and don't necessarily have a job or you are below the poverty line You're not paying much tax if any tax at all. So they can't necessarily fund that So medicare is actually a partnership where the federal government gives 50 percent and then the states pick up 50 percent of the cost The the the thing with the medicare expansion with the affordable care act Was that for the first several years the federal government was going to give 100 percent Of the dollars for medicare expansion and then I think after three years It was they were going to fund 90 percent at least for the next five to ten years That's that was free money that was coming in And so a lot of people argued not only would that help With the uninsured populations in their state It would also create jobs in their state just in terms of the additional health care workers You would need to now take care of these people that were insured the Administrators to deal with the processing of that So this was actually a potential stimulus for each of these states and particularly The republican states that really when you look at the amount of poverty that exists in their states the Regardless of what rick perry says about the job creation most of those jobs are minimum wage jobs This was something that really would have been a benefit to their state But eventually they would have to go off the federal teat and pay for it themselves Although that's it's not been stipulated when that would happen and the worst case it would be a 50 50 Split and that's what governor brown was really worried about here in california He's actually been to the right of some republican governors on the medicare expansion But at least for the next foreseeable future, we're talking at least the next 10 years The maximum that the state would be responsible for is only 10 of the entire bill. Okay now the affordable health care act is also obama care It used to be a pejorative term, but now president obama calls it obama care We've seen it working in massachusetts since romney installed it How's it going for people in massachusetts? It's it's it's been I would say there are mixed things in this obviously the number of uninsured in the state of massachusetts has dramatically dropped I think it's anywhere from one to three percent of the whole population in the state is actually uninsured But what's also interesting is and this is the criticism I have with the affordable care act Is that if you look at the number of medical related bankruptcies, they've continued to climb And that was one of the claims that's being touted by a lot of democrats. This is going to reduce bankruptcies That's not the case In 2012 there were four million bankruptcies in the united states And 66 of those four million were due to medical illness Out of that three quarters of those people had insurance The idea that having insurance will protect you from medical related bankruptcies is actually I wish it was not the case. I wish it was the case, but it won't I had neck surgery. I had a herniated disc Operated on three months ago. I have the best ppo plan. Um, I what is ppo? It's a paid provider Where I can go see whoever I want don't us need pre authorization and and and and very low deductibles But I still in the end had 20 000 of out-of-pocket expenses myself And so when you look at most of these plans the exchange is designed to set up three different types of coverage There's bronze silver and gold 60 70 and 80 percent of all of your Medical bills will be covered by the plan. So let's say if you have open heart surgery where the average Bill is going to be over 100 and you know 20 000 dollars And they're covering let's say 80 percent you're still on the hook for a big big amount of that's after obama care That's after that's what's going on in massachusetts, so they they actually showed the percentage of the population Going bankrupt due to medical illness decreased But the total number of medical related bankruptcies has gone up every single year That's one bad thing of the affordable care. The second thing was That the number of uh, the the medical costs have gone up They have not been able to rein in costs and that is another problem But the rate of increase has gone down Slightly but but but if you really look at you know, that's which was really tatted during the affordable care At the bending of the cost curve massachusetts is really running out of funds now They're They're really running into financial problems so much so that deval patrick started to call the governor of massachusetts called in a Sort of an emergency session to try to find a way to stem And greatly reduce these costs because it's not sustainable for the state of massachusetts And that isn't necessarily the insurance company's fault. Stephen brill had a great cover story in time magazine three months ago about Hospital costs, you know, they once try to audit the pentagon and they couldn't do it You know, there's a here's a trillion dollars. Just spend it. We have no idea where it's going doctors hospitals They can't tell you where the money's going or why an aspirin costs 700 bucks Somebody just goes into the back room and just says 40 bucks for a sponge. This is the david feldman radio network We're back we're back Let's stay on what's good about obama care before we get to the to the problems with it What else is good about obama care? um So I think the things that I really touted and and and then what you're seeing is the other thing is the insurance exchanges Really designed to introduce competition Where you or I if we are not covered by our employer and we need to seek insurance We can go online and look at all of the various options that are With the providers and all of these providers had to compete to get on the exchange They had to fill out some rigorous forms and meet all of these standard requirements in terms of preventative care and all of the such And you can only spend a certain percentage on administrative costs right and advertising correct The government is actually dictating how much an insurance company must spend On the patients and that's actually very good But that's slightly misleading as well and and where this stems from is this the private insurance industry currently takes 31 cents of every dollar of every health care dollar premium that they collect Out of actual patient care that money is used for overhead as you mentioned marketing exorbitant ceo salaries Administrative costs we know that the private insurance industry's administrative waste is much much higher than medicare Which we can talk about a little bit later and insurance companies consider that What they spend on patients they call that the medical loss ratio Which is says something when they the money that we're paying to take care of us They can view that as a loss So the idea is that for individual plans The insurance companies now have to spend 80 cents of every dollar on actual patient care So though they can only take 20 cents of every dollar away instead of 31 cents for small businesses And other plans they can actually only take 15 cents of every dollar away The idea is that more money will actually be used for patient care But because the affordable care act has no provision To prevent insurance companies from raising rates They can figure out well I need to make this absolute amount and if I can only take 20 cents of every dollar I'm just going to charge a little bit more Because there's no regulation on their ability to regulate rates And then the federal government says you can only pay 8 percent of your annual salary towards health care Otherwise you then qualify for federal subsidies. Correct. So it would be the federal government Picking up the slack there and corporate welfare for the insurance companies, basically, right? Right. So here's the thing about new york Prime example, so everyone was touting that new york had this they opened the exchange and a lot of premiums were 50 Lower than what they had been the year before The idea was the exchanges have opened in new york Well, I mean, well, this is anticipation of the opening in 2014 A lot of people are starting to show the prices covered california, which is the exchange for california Announced the participating insurance plans and the prices there. They are actually quite quite Reasonable and and this was a big headline in the new york times Two weeks ago that showed that the individual market the cost would be cut by in half by 50 percent for the individual market What people don't realize is that's really predicated on the individual mandate really enforcing people particularly young people to participate Because unless the young lower risk healthy people come in to spread out the risk The premiums that's the only way the premiums are coming down. That's what the insurance industry is banking on now people did a study that most the most Any individual will have to pay as a penalty in new york city for not Participating on the exchange is 695 dollars and how is that enforced? That's the thing That's what people don't realize that the are you expect to enforce is if somebody comes into the emergency room and doesn't have Health insurance to report them to the obama police. Here's the biggest sort of house of card Problem with the affordable care act in terms of the individual mandate, which you've brilliantly touched upon There is no enforcement mechanism If you read the bill The top experts have said there's absolutely no enforcement mechanism So that that that is something that needs to be the individual. That's how it got passed, huh? The individual mandate Says everybody in america has to buy health insurance roberts the chief justice of the supreme court says that's a tax So it's constitutional Everybody has to go out and buy a product. They have to buy Health insurance or have health insurance or have health insurance But but the actual if you really carefully read this And there have been several people that have actually published essays on it. There is no enforcement mechanism there It sounds good But there's nothing that says the irs has to come after you and put a lien on your wages or anything along those lines So the idea is that if everybody has to buy health insurance then Young people are covering the costs for old people And profits for the insurance companies will go up because more people are buying health insurance And if the profits go up supposedly the premiums go down what What in history has ever shown that health insurance companies Will lower their premiums because they're making a killing they won't and I will say one other thing If can you other than the military industrial complex and maybe the prison complex? Over the last 10 years during the worst recession that we've ever had in our lifetimes Can you think of any other industry that had double digit increases in price and profit year after year after year During the heat of the recession No, right the the health insurance industry was one such industry So the health insurance industry There's no cap on their profits even though you're supposed to spend 80 percent on the patients They can make as much as they want under obama care Correct and they can charge as much as they want and the federal government will pick up the slack for people who can't pay those premiums Which means that The insurance companies are going to raise their premiums because they can get away with it They're not going to treat health insurance companies like a utility No regulation Well the insurance industry will argue that they're getting more regulation because they're having to cover more things And and sort of the golden days of taking 31 cents is no longer there that 20 cents is a huge burden and a regulation on them The the problem is this you've you've Outlined but still sounds like a pretty nice sweetheart deal for the insurance industry Right, there's no public option to compete with them All right, and when you have to find public option, please So the public option was the idea that because insurance companies don't always play nice that there would be a government run health care plan Let's say there was Medicare that would be on the exchange So you and I could choose do I want to go with lucros or or kaiser or etna Or do I want to take the government plan and the idea with the government plan was rather than Raising prices to satisfy shareholders in return that whatever money they made They would keep pouring it back into the system to keep premiums low for the following year a true not-for-profit But don't they in the exchanges don't all the consumers have to be offered a not-for-profit Insurance plan well that but not-for-profit when it's non-government is very misleading but let's backtrack for one second doctor According to obama care when you're shopping for Health insurance one of the choices you have to be offered Is a non-profit health insurance group correct right, but non-profit and health insurance are Are are are really the country's insurance? Yes, I in the sense that this I'll just explain two two things kaiser is not-for-profit if you saw recently they were Featured as having raising premiums just as much if not more than a lot of the private insurance Kaiser was the basis of hillary care right right right. I mean that's the well Again, we can we and it and it's to some extent the basis of the accountable care organizations that exist within The affordable care act that it's encouraging specialties to come together to form a sort of a pseudo hmo So you're saying that the government can run health insurance better than a non-profit can correct Which goes counter to what every republican will tell you correct and and there's actually data to that So uh independent of an ideological slant, which is what I always say to people is let's take a step back and look at the data There's been lots of publications Most recently kip solven who is a a physician and also economist at in minnesota Published a paper showing that the admin is true administrative costs for medicare were 1.4 Versus 16 percent for the private insurance industry right and that's a fact. Yeah, that's that's undeniable That's undeniable and and so and and I would argue medicare would actually function better had it not been jeopardized by Both the republicans and democrats and the house and senate Starting with back in 1995 During the original budget battle everyone said medicare was going to go broke The republicans at that point wanted to put 20 of all seniors were on medicare on medicare hmo's or a privatized version And they said over the next seven Years it would save, you know 200 billion dollars Well fast forward it's actually cost over 277 billion dollars more To do that because you had a for-profit entity that was being less efficient taking care of these people So part of medicare has been Privatized correct and that was the argument with the whole paul ryan thing with the obama is trying to cut medicare he was just trying to finally say to the medicare hmo's That we're going to pay you the same thing we pay everyone else With medicare because you have not shown better outcomes and you've only Cost more money than what what the traditional medicare plan can do Plus we also know that excuse me for i'm sorry to interrupt So you're saying that under obama care they're taking back medicare from the hmo's Well, that was the original plan and here's the here's the but they're not doing Well, here's where you start to realize that sometimes you don't have democrats and republicans. You have corporates. Yeah Because the plan was that in 2013 starting this year That they were going to start to cut reimbursements to medicare hmo's and and and doing so that was going to be begin the savings of that 877 billion dollar that you know that ryan and romney kept saying oh he's cutting medicare by that much But what did sabilius announce last month that they were his health and human health and human services secretary That instead of cutting it like they said they were going to do they're going to reward them and give them a 3.5 percent increase So that's further watering down the solvency of medicare and that's democrats doing that But let's look at what the republicans have done first thing was i mentioned starting this whole mess by putting 20 of the medicare seniors on a privatized plan which has actually been more costly and less effective Second thing was medicare part d which was the prescription drug plan And what people don't realize and this is what i always when i get into debates with republicans And we don't want a government health care program They passed a much more massive program than the affordable care act And you didn't hear anyone on the right talk about that But that's what i think the left needs to constantly bang them over the head and say Medicare part d is much more expensive on a yearly basis than the affordable care act was And what that was was quote a a plan to give seniors a prescription drug benefit What did we find out from that it was initially started by a republican house and senate And billy tauzen was the lead author on that we're seeing these days He's now the president of pharma, which is the the the largest lobbying group for big pharma Making more than two million dollars a year is that position talk about a revolving door So he negotiates this and then becomes head of pharma. So that that's what billy tauzen did It was signed into plan what it does is it prevents medicare from negotiating bulk prices on drugs As a result, we're spending about 60 percent more on drugs than uh per capita than they are in canada on our seniors Right and when obama First proposed obama care Who was the first group he made a deal with billy tauzen? He was in the door and they were the ones that said we'll give a couple hundred million dollars so that you can air ads That will be favorable to your legislation as long as you don't allow them to touch The the existing plan uh the the deals we have with with uh the big pharma So the drug companies support obama care and they were in on it from day one correct The health insurance companies They were they on one hand they were against it and then on the other hand they were in it And here's the thing that people don't realize so they're 535 members of congress There were over 3,300 registered health care lobbyists So roughly six a lobbyist for every member of congress and they were spending 1.2 million dollars a day more was spent Lobbying for health care Then was on the entire bush carry election And that's why the bill as you mentioned looks like it was written by the private insurance industry Say that again more money was spent Lobbying for uh the affordable care act So that it would be favorable that there would be no public option and all of those things Then was spent on the entire bush carry election Wow Yeah, and that's why the bill looks like it was written by the private insurance industry That's always been the ding on on the on the legislation is that it it's really I always heard it it was crafted by the insurance company insurance industry and now here in the specifics It seems that that's the case. Absolutely. And I think that again So we have to look at the good things that are there that Maybe the insurance industry didn't want which was the lifetime caps as I mentioned and no rescissions and pre-existing conditions But in the end out of that 800 plus billion dollars It's estimated 475 billion is going to go to the private insurance industry. Say that again. What? Out of the you know, the total cost of the affordable character is 800 plus billion dollars, right? It's estimated that roughly 475 billion dollars of that will actually go In terms of subsidies and such to the private insurance industry, but not as profits No, no, but that's money that's going to be used to go buy their product. Okay So where else do you see the government taking tax dollars to subsidize people to go buy product from an unethical and moral industry that only profits by denying people care right That that's that's that's the problem that that I see okay and going back to medicare We're celebrating its 48th birthday medicare was monolithic There was I would assume it was a much smaller bill fewer special interests Lyndon johnson had a bigger majority in the in the house in the senate to pass it Was medicine for profit when medicare was passed? When did medicine become a for-profit enterprise? It's actually been for profit for quite some time now. It was not hospitals used to be I think weren't they run by the catholic church or Temple Israel or a university They weren't supposed to make money. I thought at one time At one well again like like anything it was I would say this there were always Very altruistic not for profit truly not for profit hospitals particularly a lot of the catholic hospitals As you mentioned a lot of the jewish hospitals cedars when it first opened its mission was really to care for everyone And same thing with a lot of the catholic hospitals you see Even organizations like blue cross and blue shield initially Came out of really good intentions So blue cross was initially founded in texas. It was called burning cross at the time simpler time A lot of the teachers They basically got together and they went to local hospitals and they said we'll pay you a set monthly fee If you take care of our our our teachers we're talking about what are we talking like 20s the yeah in the 1920s And and and and that's how initially blue cross was initially started Blue shield was actually started up in the pacific northwest, which was a plan for basically lumber Workers that they pooled together and they went to groups of doctors and they said If our workers get sick, we're just going to pay you a monthly fee and then you'll take care of all So both of them were born out of just true free market Really, let's let's do something that makes sense win-win for everyone Then then probably a lot of people argue that as the it was it when uh during the nix administration He actually tried to Clamp down a little bit on the private insurance industry Because he saw things were were were changing but somewhere between that period of time To now and particularly in california with the managed care situation um But it used to be Doctors got rich right doctors were wealthy right hospital administrators were bureaucrats And people didn't buy up hospitals to get rich right so somewhere along the line they figured out a way to monetize Health care and and health care is much simpler back then as well You didn't have all these fancy tests. You didn't have high malpractice. You didn't have a cut throat industries where A doctor would move right down the street from you and try to undercut your bills. It was a much Much more civil much more sort of simplistic But companies like well-point didn't exist 15 years ago And companies like that really Really happened probably in the last 15 years where you had a massive consolidation of the health insurance industry And in order for your plan a single payer to come in to existence you would have to put a Multi-billion if not one trillion dollar industry out of business You can't do that in america Well at least that's what we're going to keep trying this is the david feldman radio network The david feldman shows available as a podcast for free on itunes For a treasure trove of more free stuff I invite you to check out david feldman show dot com Where you can find podcasts radio shows and reading material Dating all the way back to 2009 and it's all free david feldman show dot com And while you're over there, I invite you to subscribe to my newsletter We're back. I don't know if we got the last part, but I would assume the health insurance industry, which you say is only 30 years old is now a trillion dollar a year Business if not more in order for your plan a single payer Socialized medicine to go into effect. You would have to put an entire industry out of business And in america, they can't do that. You cannot put An industry out of business. It's impossible. Well, we're not going to put them out of business We're just going to change the focus. They won't be the primary provider They can be the supplemental insurance They can they can take that tax and if you look at countries such as taiwan that institute a single payer system within a year switzerland changed and changed the emphasis of their insurance Companies and it's possible. I don't think it's possible on a national level like we want to do because Of the dysfunction in congress, but I do think that we can start in california where the more people see More and more their paycheck every year going into health care And yet still not getting the coverage that they desire and their dissatisfaction continuing to climb And being educated about a real proven alternative that exists. It's not theoretical. It's been going on for years What's going on in vermont? So vermont is is one it's got a population of six million. So I don't necessarily think what happens in vermont will be A good test for the rest of the country They are trying to establish a single payer system, but it's it's not Really going to be where you eliminate the private insurance industry As it stands right now It seems that people will have an option to buy into a system But it sounds like more of a public option rather than a complete elimination of the Other providers and the problem is this as you touched upon It's not just the private insurance industry while they're a big part of this It's also the inability to Have a consistent system in terms of the way physicians practice the way drugs are negotiated Prices are negotiated If you have multiple players in the market that are competing against one another that that's sort of the problem That's why when I see a patient my office staff has to spend so much time getting pre-authorization from that patient That's different from the next patient I see who's got a different health insurance provider And why blue cross may pay me such and such to take care of this patient But etna may only pay me something and You can imagine the administrative mess part of the idea behind a single payer system Is to eliminate the administrative mess by having one uniform pricing So whether it you're going to have a hip replacement at this hospital down the street or in Ohio or florida It'll be the same price and the doctor will get the same Percentage the hospital and then afterwards the drug that you need to take to recover That will cost the same no matter where you go The idea is by doing that then my office staff doesn't have to spend all that time Negotiating or fighting for authorization from all those places. So the administrative simplicity Will save the average doctor 70 000 a year in administrative costs. There's been a study showing that But more importantly in terms of the the whole system That's where the the great savings is anticipated to be about 400 billion dollars a year Okay, so there's a lot of blame to go around I blame people for getting sick But doctors were against the AMA was against medicare correct. They actually that they launched ronald reagan's career Uh back then they coined the phrase Socialized medicine and the only thing I would say is that single payer is not socialized medicine Socialized medicine is where the government pays for and operates every aspect of the health care system They own the hospitals. They employ the doctors that england. That's great. Yeah, which is the closest they have to a national religion You cannot get rid of Socialized medicine in great britain. Even margaret thatcher was in favor of it She protected it and she proudly upheld that But that is actually a socialized system. We actually have a socialized system here where the government owns and operates The hospital employs the doctors. It's called the va system ironically the system that takes care of our Are enlisted and our soldiers is a socialized system and it was good up until a few years ago Correct, although it is starting to become better with the increased efficiencies that they're having But it's just again where the big problem as you Uh alluded to is so medicare would be single payer, correct Medicare, but it would not be socialized because the doctors would still work for themselves the hospitals Could remain independent all aspects of of that. It's just instead of dealing with Again, 12 different insurance plans. We will only have one insurance plan to simplify everything Where's the am a on this and is the am a still important? I uh, I I I I would say this the am a is still important in the sense that from a Average citizen they view that as the mouthpiece for physicians But there are actually more physicians who don't belong to the am a now than actually belong to the am a right So I think they're they've really shot themselves in the foot. I was a member of the am a up until 1992 When they came out against uh, hillary's plan without even reading it and it was purely based on ideology You had sort of the leadership of the Am a at the time was much more aligned to the right And this was much more ideology without even them reading what was in the plan And doctors have paid a price for this You're not making the money that you guys used to make. No, I mean, I've been I went into practice in 1995 and I have My best days were in the 90s But what I realized for me Particularly as somebody who treats cancer I see too many of my patients who've worked their entire lives have insurance still go bankrupt Still get denied the care that they need from a for-profit system And then I also see patients who can't come to see me Because of their insurance plan telling them they have to go to a different provider And then those that are uninsured all together who never even get their cancer diagnosed. It's not a free market It is not a right now. It is not a free market You have to go see the doctor who your insurance company dictates. You see You you can't shop around. I can't say what do you charge for chemo? The guy down the street is 20 bucks less. I'm going to go see him So why aren't the doctors united? You've been divided, I think by your ego the idea that Your chemo Is the same as the other doctor's chemo is insulting to your ego, right? Not you necessarily But what I'm saying is the reason the doctors can't act as one force is You're competing against each other. You all think you're better than one another You all you think you're worth more than some other doctor which may or may not be true some doctors are better than other doctors and They do have a right to feel they should be paid accordingly, right? I think so, but here's the thing. I wish it was I think all doctors. There's an ego element for sure but having witnessed the Lunchrooms and hospitals during the elections There is clear differences in ideology There are doctors that are completely aligned with the 1 and then there are those that are Much more aligned with the 99 percent But you don't treat a disease based on ideology you treat it based on facts And we have a disease in this country. I mean cuba has a higher life expectancy than the united states This is we're a diseased nation, right? So here's the other part So, you know, I've pointed out all the failings in the healthcare system except where the doctors lie And part of this is in something called fee for service Doctors don't get paid based on the outcome. They get paid on how many tests they perform You know orders they give and what procedures they do And so if you are a physician particularly in the last 20 years where your reimbursement gets cut and cut each time you see a patient You're more aligned to try to augment your salary by performing additional tests Maybe they're not always necessary for the patient One of the things that I think has to change which the affordable care act is actually trying to do Is do away with this fee for service rather than pay you per procedure They want you to look at outcomes. They want to see they'll give you a lump sum of money to best manage this patient And when you have that money up front guess what you may not order the tests that you Really don't need to do but you were doing because you felt you would get extra money Now you want to keep that money in your pocket and be much more judicious With how you use that money to to cure your patient That is something that is is is a positive that I think will happen With regard to the free market. Here's the the the other fallacy that I always say to the right There are only two industries that are exempt from antitrust exam Get antitrust exemption in the united states major league baseball and the health insurance industry And yet in the last Because of the consolidation if you go to most major cities in the united states Most markets the top 200 markets are dominated by one to three maximum health insurers In the state of alabama 90 of that state of those that are insured They have a very high uninsured population, but those that are insured 90 or blue cross So you mean to tell me what choices do you have? You know, everyone's let the free market work There is no free market I I can't necessarily negotiate a good price and and the other thing that I thought you said also baseball is subsidized by municipalities The stadiums are all built corporate welfare right there and they don't create jobs No, when they when the Yankees threatens to leave They say you're going to lose all these jobs and they've crunched the numbers and they've have found that the Yankees are drain On new york's economy and and i'm sorry go ahead No, no and and and I think that that that is the situation a lot of these health insurers I've consolidated and they dominate the space. So they you have no competition So if you don't want to pay their premium, you don't have a choice to go do To hire somebody else. That's where this exchange really has some benefit Now some of the health insurers that are participating in this are are a small fraction of size of a blue cross or Or some of these well point like well point shows not to participate in the state of california But at least you're given a little bit of Choice to do to take care of your needs. So that's that's one issue The second thing as you mentioned well point will no longer be in the state of california for not this small individual market plan They're not participating in the exchange That's good It is good But but one of the things that the dave johnson insurance commissioner points out is that The the you don't have as much choice and he would have liked to have seen more choice Uh in the exchange so certain hospitals chose not to participate in the exchange cedar sign I chose not to participate in the exchange. So what happens? How do you go to cedar sign? I if you are an uninsured individual that has to go buy insurance under the individual mandate You can't get coverage to go to cedars And that is one of the again limitations of the affordable care act is that there are even though you're insured And it'll meet your basic needs. You may not be able to go to the hospital that you want to go So that becomes a certain elite hospital brand Or or or brand of doctor in this case as well Who's not I mean, is that what it builds? It's sort of a strata of of healthcare that You can't reach if you're if you're under sort of the the mandated insurance And and it goes yeah, that's absolutely correct And and and that was not the intent but that's going to happen and then the second thing is this medicaid Most doctors I've always been in a group where we take medicaid no matter what but most doctors in the area Do not take medicaid because the state of california's reimbursement is so low. So You're a second-class citizen there too. And even what do you mean? You don't take it. So in other words, if somebody Comes in to see you and they say Unbroke medicaid is going to pick up the tab here. You you have to say no There are doctors that will say no now the only time that you have to see if they show up in the emergency room No hospital can turn away anyone regardless of insurance status But as soon as they get you stabilized if you're medicaid they will get you out the door and send you to the county hospitals But fox news tells me that Everybody has health care in this country. So you go to the county at the er they do Okay, so now you're sent to the county hospital and you say, you know what doctor? It's been five years since my last colonoscopy. Why don't we why don't why don't you give me one? Are they going to give me a colonoscopy under medicaid? Not not not right No, not not right away. Now. Here's the thing They will and if you are eligible meaning you you make less than 138 of poverty They will they have people that will enroll you into medicaid And from that usually with social workers and such they will get you tied into doctors Hopefully that will see you and and do the necessary tests Immediately to take care of your immediate health concerns but then eventually you get you tied into a primary care physician who will then do all the Subsequent necessary colonoscopies all paid for by medicaid medicaid, but here's the tricky part of that There are so few doctors that accept medicaid patients That it's really hard to find somebody and then when you do find somebody there's generally a long waiting list to see that person Why do we only have 200 medical schools in america? Good question I I think this is a big big problem because there's a big shortage of primary care physicians And that was actually one of the things that I was working on with commissioner jones So now you're going to give people insurance, but you don't have enough primary care physicians to take care of these people That that's a problem What the other thing is because we only have 200 medical schools here. I made that number up, but it's something like that It's very small. Yeah, it's about 200 that you're getting A lot of very intelligent worthy students who don't get into medical school And not to take any way thing away from four medical students But then you're getting a lot of foreign medical grads who are coming here and filling the jobs because there's a shortage Clearly we need more I think part of it is again medical schools are very expensive for universities to run They used to be a very boutique thing that they were proud to have But it's very expensive now to to have a medical school. And then the other thing I think for a while was doctors they didn't want too many doctors Supply demand. Yeah to keep the supply down. I think that was the other thing that's come back to roost now Right, so the doctors are complicit in some of this I think well, I think we have less say now in terms of how medical schools are but at some point there had to have been some Greating of a priesthood Could I get back to cedar sign? I you said it wasn't their intent to become Exclusive, but do we know what their intent was? Do they just miss the filing or or what I think cedars looked again I can't speak for the administration I think what it is is the hospital is super busy already And I think they felt that entering the exchange probably would just increase the Flow to a hospital that was near at near capacity us news and world report their big money Is grading colleges That's where they get all their money by the way us news and world report Is pretty much out of business right? It's all about exclusivity And they do these studies on what the best hospital is and how you should shop around by the way us news and world report Which is so busy judging the competitiveness of all these universities and hospitals They're pretty much they've gone out of business. And isn't there another organization that judges hospitals and their annual Report is completely different from the us news and world report. I think you're right. Does it pay to shop around for a hospital because If we're going to go with single payer and I agree with you I'm for socialized medicine. I think medicare Which isn't socialized medicine that's single payer It's successful medicare is an example of what big government can do right Shopping around for a doctor in the end people like to think they know the best Doctor in the end Does it really get you that much? Depends on what you're having done right and then also depends on the cuteness of your injury or your health condition Sometimes even if you wanted to shop around you have to have your appendix out immediately And you don't have a choice or you have to have bypass and you don't have the chance to go down to the hospital From the doctor that operated on your uncle right So But I do think that for a lot of more elective things or things that are less emergent It is important to ask around I say that all the time for cancer treatments as well There are people that have quote great reputations because they've been named to some list But they haven't put a hand on a patient in years, you know, they have residents that take care of people So I do think that patients should feel empowered To make the decisions and find out who they feel most comfortable with with their care um, there are some people like my mom had a hip replacement and the Guy's a great surgeon, but she couldn't stand his lack of bedside manner Right, uh, and she probably wouldn't recommend him to somebody else You know, there are a lot of in terms of the results the result was great And and I think a lot of that is is what is your I always tell that to my patients You are the ultimate boss. We work for you. Not the other way around right Finally and I'll ask this of dr. Nancy Who's been talking way too much I'm learning did you become a doctor? because of money Did you go into medicine because you heard There was gold in them their hills Nothing would be farther from the truth No, no, no, and I I I presumed I'd be I would have earned a comfortable living, but I didn't expect I didn't go into it for the money Uh-huh I like to say that it's way too much work for anyone to go in. This is the david feldman radio network Are you listening to the david feldman show as a podcast but would like to hear it broadcast locally Please contact your local public radio station and tell them you want the david feldman show We're back dr. Nancy if I were to say to you You get to be a doctor You're not going to be in debt your medical school bills have been paid when you retire You'll live comfortably, but you'll never be rich, but you get to practice medicine for 50 years Would that seem like a a wonderful thing for you? I think you're pretty well describing me If you say to most doctors you can start your medical career right after Medical school you won't be in debt the government will pay your whatever cost you to Go to school. You're going to work for 50 years treat people Then you retire You're not going to be rich. You're not going to be poor But you get to practice medicine now. I I think that there is a big turn In medicine And I have been in practice just a few more handful of years more than Dr. Song here, but I I saw it really change And that was the end of the 90s the beginning of the next century and that's when There were suddenly a lot of hmo sprouting up physicians started getting together And things started being squeezed And you squeezed all the little extra time a little slop out of it And I had one very respectable good friend pediatrician who had invested and made a lot of money out of it But those got gobbled up and it was the corporatism that That moved in and there's nothing more to squeeze out of it and people keep wanting those profits And you just keep cutting and I think that there's a big divide among physicians because those Who have got into a specialty that has lots of procedures? Which is reimbursed. It's black and white. You check the box. You did this x-ray. You did this procedure You get a certain amount, but those of us and I'm in an area which is still very much an art No one pays me to spend time with patients And It's black and white and there's you know when I learned that the surgeons in my specialty Were making 20 times what I make It it blows by my those numbers are incredible. But is that going to change? Are we seeing more and more Medical students going into it for a love of medicine and not a love of money? Are they no, I think the opposite Yeah, could I say something here in my limited experience? Because I'm I don't play a doctor on television or anything But but I've noticed that in journalism and in medicine the same trend It used to be people majored in journalism and they they were interested in in entering that that estate and and Kind of doing good things Now it's called communication And they're and the majority of them seem to be looking forward to working for pr firms public relations firms because that's where the money is And similarly in in medicine the two of you Graduated and were educated at a time when you weren't encouraged to As I as I get the sense that people are now who are coming out of these medical schools To to call for all of these unnecessary tests Because they get paid for them and it makes the hospital administration happy if they do that Let me have one more one more comment on that probably you're not wrong, but I have a thought that all of the procedures that and tests that get ordered Aren't because you get a kickback as much as it takes less thinking If someone comes to me with a headache, they don't think I've done anything until I order an MRI And I say but I've told you what's wrong. I've told you how to fix it But you've not ordered an MRI And that is the thinking of our society That has to change and by the way, maybe a little different topic I have six high level World famous people in my career who are my personal friends Who literally well four of them were americans who went to canada because they can practice medicine there And they love medicine and they love research in medicine And they wouldn't come back to america for anything And I have to say one reason I I'm so happy to be in the presence of these two particular doctors Is they're both associated with something called PNHP, which is physicians for a national health plan health program health program. Thank you I've I've been to some of the meetings of this organization and everyone there just seems knowledgeable and and Selfless is the only word I could think of in in terms of their pursuit Tell us about PNHP and what can the people who are listening right now do to help you Well, I think the first thing we would encourage them to do is go to the website www.pnhp.org They will be led to a plethora of essays and articles and peer reviewed publications on the benefits of A single payer health care system as well as the limitations of the affordable care act As well as the limitations of free market system approaches So that's one of the things that they can do and sign up and they will get a daily quote of the day There's a an amazing gentleman by the name of don mccann who Scours the new services for a tidbit and then breaks it down into a very very Well written and truly informative health care policy Issue for yeah on a daily basis That's one of the things I would very much encourage people to to sign up for and if i'm not mistaken PNHP is similar to women in film and women in animation In that neither of those organizations is limited to women I was surprised to find out and PNHP physicians for a national health program Is membership is not limited to physicians. Correct. We often debated whether or not we should change it to health care providers or people for a national health program It just happened to be launched by physicians and the idea was initially we wanted to Change the minds of the medical community if we could do that then you would get a very powerful voice to speak out But as you mentioned there are big problems and and a lack of unity in our Community to begin with but if I were to Say that I was a member of PNHP a woman might think that I was a doctor and I in a bar situation Might be able to have a little more romantic cred I'm just saying so PNHP could help me in that way by by becoming a member a better endorsement I've never heard. Yeah, you know I when I was in college My best friend was going to a medical school and he gave me scrubs And I used to walk around in scrubs That's a great play and I met a girl at a party. I used to do this until women that I was in a A six-year medical program It never got me in bed, but it got me close For sometimes close is better. Yes My bedside manner wasn't good enough to actually get into bed with them And I'm going ahead and I was at a party. This is the last time I did it I met this really beautiful girl and I told her I was a medical student And then she starts telling me about her mother and how sick her mother is and I spent two hours Just diagnosing your mother. No just comforting her and making up stuff And it was one of the worst nights in my life just pretending to tell this girl that everything was going to be okay What were you going to say mark? I was just going to say that that that scrubs you see doctors I presume that they're all real doctors or that they work in real medical facilities You see it in Beverly Hills and West Hollywood these guys run around at the lunch hour I mean, I guess they're literally just going out of a lot in Beverly Hills I Beverly Hills I assume it's mostly cosmetic stuff that they're just you know, they're out between breast augmentation or something like that But it is doing the lord's work doing the dark lord, you know, the favorite lord Anyway, I do think that it's still being employed by by some is what I guess what I'm getting at When medicare was by the way, I prefer simply a stethoscope and a reflector And completely naked When medicare was passed the republicans didn't sabotage it Correct. Once it became law of the land Initially doctors were resistant to try to take patients for medicare, but the congress went along with it They didn't try to repeal it 40 times Yeah, it needed to be tweaked a little I would assume it wasn't perfect On day one it's close to perfect, but it wasn't perfect on day one And it's well, it's correct. It's a work in progress and it's still not perfect now And and you know the in the reality is most seniors who have medicare Are still going to need to find a way to cover a lot of their medical expenses It doesn't cover everything medicare part b only covers 80 of all outpatient procedures. So Seniors are on the hook for 20 20 cents of every dollar there So the idea is that we need to try to strengthen and and and further build upon medicare and improve medicare But then offer it to every single person in the united states and I would assume PNHP your organization Is not going to sabotage obama care We do have some people who are very angry at what was passed But all in all I think the majority of us do feel that It's still better than nothing. It's not what we would have hoped to do But it really doesn't serve us any purpose to to sabotage it But this isn't the same country as it was 48 years ago Are we capable of tweaking obama care? I think it'll have to be done on a state-by-state basis where you have Innovative governors and legislators who are willing to look beyond ideology and try to do what's best for their citizens You know, I like to think that obama ushered in a progressive wave and that we would see a return to bigger government I don't think the end has come yet for reaganomics. I think it's just begun. I think This federalism the return to the states is exactly what reagan and baner and the republicans wanted And that's just beginning. It's I think unfortunately we're seeing a second phase of Right-wing politics. How far can that pendulum swing? Well, they they've strangled the beast They've created paralysis in washington dc and now it's up to the states That's exactly what the republicans wanted and that's what we're saying now and the supreme court just ruled that way too Yeah with uh with the marriage equality For a couple of years. I was saying that obama was ushering in this new wave of progressive big government politics but I think the coke brothers and alec are succeeding locally and That's where we have to fight them now and the fact that we have to fight them in the trenches in the In the states and thomas friedman in the new york times wrote that the big job now is to be mayor That's where all the fresh new ideas are coming The fact that you really have to get down and dirty Is the triumph of raganomics and we're losing we really are losing that they're just they've got more money they've got more power and the fact that We can see virtue now in states rights It's pretty scary. Well, and by the way the coke brothers Specifically have a strategy that very much takes stock of that as you know, they've they've turned from federal Obviously, they're they're very very active in their lobbying at the federal level, but they're really getting that grid down to dogcatcher type type level they are Pursuing local elections that you would think would be well below the altitude of the kind of thing that they concern themselves with But quite the contrary they're in anticipating exactly what you're saying So that they are working on every level and on a granular level They are active and their money is very much in place. So it is a battle I think even at the very at the very most at the most local levels But why are people buying into it? Because it's a lot of it. You got so much attention has to be paid to this stuff Americans can Have to understand it and one of their agendas is to under educate Our whole education system is not bringing people up to the level that they actually have any critical thinking And I would even go even further even if we did have an educated mass A lot of our districts are so badly gerrymandered that we can't get what we want anyway And I would say in california, you know in 2012 we finally had a democratic legislature house and senate and then uh, and governor brown, but we had uh, and we passed this single payer bill it failed by two votes And six democrats either voted no or abstained So it's not always republicans that do that and when schwarzenegger was in power They gave him safe cover because they knew he would veto it But when push came to shove these guys were all beholden to the private insurance industry And and that's where it gets back to it. You know, we don't necessarily have democrats and republicans We have corporates and and that's that's the real sad part of this you guys are supermen ubermenches super women What is harder to crack organic chemistry? Or the inner workings of our health care Not medicine, but how health insurance works and how things are paid that bureaucracy i'm being serious here What is harder to understand organic chemistry? Or how our health care system works? Well, I'd like to answer that I'm being asked a serious question is I would think trying to figure out well point Is harder than Absolutely organic chemistry was right there. You study the same pages. This is a moving Event that's changing every day You know the the textbook that that I was taught organic chemistry in the Mid 1980s is probably still the same textbook they're using nothing's changed in organic chemistry But as you mentioned earlier health care is just dramatically changed and for the worse and if it goes state by state How can somebody as brilliant as you keep abreast of it? Well, what I think the reason why i'm so focused on california is because we have a super majority in the house and senate And at some point that will pay dividends and if not, I think as we educate the consumers That initiative can indeed happen california is still the eighth largest economy in the world. So if I before I lived in california used to resent it when people say as california goes so does the nation But if you really could show this could work in california And it's the only place with the political appetite to really make it happen Then I think you will absolutely blow all of the fallacies and myths have been perpetuated by Those that are against it And and people's will readily adopt it finally Let me just mention that the two of you dr. Nancy naparco. Did I pronounce that right? Yes And dr. Paul song will be at the historic aero theater In santa monica august 1st 7 30 to discuss PN hp a single payer health care system here in the united states and they will be screening the movie the health care movie Narrated by kiefer southerland Everybody should go to w w w p n h p And Support health dot org right dot org support health care For all americans. It's a disgrace the way we show up at the w h o their listings Where we are in infant mortality Longevity we're not the greatest country on earth stop thinking that we're not And if you can't make it to the aero theater this thursday You can go to p n hp website and look it up for to Find the showing near you or it is not too difficult to arrange a showing and uh p n hp will Very gladly help you arrange a showing if there's not one available all arrange is showing if I could get an exam Throne in yeah one of the p n hp dot org doctors could come by and just do a little um we've got gloves in the car There you go. Finally Finally you guys have seen The absolute worst As doctors stool transplants. Did you ever think you would live long enough To hear of a procedure called a stool transplant? Isn't that I at some but there's a reason that it's been tried There's a rationale to it A lot of things you think are pretty gory until you get Interested in it and understand it People donating their stool So it can be injected into somebody else's stomach Wow But I guess somebody's making synthetic stool, right? Not my area of expertise I can speak to that with some authority doctor Look, I've got a couple of bunts and burners fired up on this david the research i'm doing It's a small i have a kickstarter campaign. I'd like to talk to everybody about Artificialstools.org Thank you guys That was great. 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