What The Presidential Candidates Aren’t Telling You About Healthcare

– Hey everyone ZDoggMD. I’m actually a doctor so this is something I care about, unlike the politicians who talk about it all day long. And that’s fixing healthcare, covering everybody in the country. The so-called Medicare for all that’s being proposed by the current presidential candidates on the left. They’re not telling you everything guys, and I’m gonna try to fill in the blanks.

Okay, Medicare for all, what does that mean? Typically what they’re trying to say is they wanna cover everyone in the country with a single payer healthcare. There’s one thing we bill and it’s the government. And they wanna model it on Medicare, which has been quite successful for people 65 and older and with particular medical conditions. So they said why not just expand that to everybody? Like the rest of the civilized world, we’ll cover everybody. And so the Democratic candidates in particular are pitching different versions of this. Here’s what they’re not telling you Medicare in it’s current incarnation covers 90% of the total allocated costs of care. Robbie Pearl wrote an amazing Forbes article spelling this out.

So if they’re only paying 90% of the costs, where are hospitals and doctors and health systems actually making up the difference? They are overcharging regular commercial insurance, which is typically paid for by employers and individuals. It’s called cost shifting. So they’ll charge those guys 120, 130% of what Medicare pays for a given procedure or whatever. Well so that’s how the hospitals are able to stay solvent and make a little bit of profit while providing care to everybody because Medicare doesn’t pay for it all. So what happens when you have Medicare cover everybody? Doing the math on this, we’re covering 90% of the costs. With no one else to cost shift to, what’s gonna happen?

Either hospitals on mass are gonna go out of business, people are gonna stop going to medicine because there’s not enough reimbursement or we’re gonna have to make up the three trillion dollar short fall over the next 10 years with guess what? Higher taxes or printing more money, both of which result in higher taxes. Either inflation or taxes. That is very, very expensive and nobody’s talking about that. Some of the Democrats are saying well how about we do Medicare for some and then have commercial private insurance cover everybody else?

Well, guess what’s gonna happen? When people realize that the public insurance is cheaper to free, they’re typically gonna go for that. Then the hospitals are gonna try to cost shift to the private insurance, that’s gonna get so expensive that no one’s gonna buy it, they’re gonna go out of business, and you’re gonna have Medicare for all. So really Medicare for some is Medicare for all. It’s the same thing.

What’s the third sort of proposal? You know you have what’s her name from California proposing that why don’t we make it Medicare Advantage, which is where companies sort of compete with these narrower networks and they administer the Medicare for all in this competitive private way. Well what they’re not telling you there is that a lot of these networks are really narrow, and that means you’re gonna be limited in the choice of who you can see. Now some of the best Medicare Advantage plans actually include big hospital systems with integrated multi-specialty groups, and they provide great care. So if it’s done that way that might actually work.

Well, so now we have a system that’s either gonna bankrupt us or put a bunch of healthcare people out of business or severely limit your choice. Doesn’t sound great. Is it better than what we have now? Well that’s the Republicans piece, is well no, it’s not. So either we keep what we have now, not gonna work, gonna bankrupt us, we’re done. We’re already spending like 15-$20,000 a year for families, it’s crazy. Okay, not gonna happen. What did Trump say? Well maybe we can repeal the Affordable Care Act, and we’ll just make it more affordable by having cheaper insurance plans that cover less. Have you tried the cheaper plans? They don’t cover some maternity care, they don’t cover preexisting conditions, they have a really high deductible before you even get care. So it’s almost like not having insurance.

So the Republicans haven’t done ish either. Well it turns out most people identify someone in the middle. 40% of people identify as somewhere independent. It’s the extremes that are dominating the conversation.

Now let’s pretend something really dumb, like I’m running for president as a doctor. And guess what? If I’m running for president, I don’t wanna win ’cause that job looks terrible. So you know what I would do if I don’t wanna win? I would tell you, the American people, the truth. And here’s the truth about how to fix medicine, what they’re not telling you. Who cares about how to pay for medicine? Who cares about how to cover everyone? Yeah, those things are kind of important, but who cares about that stuff if what you’re paying for is fundamentally broken? You wanna take Medicare for all, take the common money and cover something that wastes 400, 500 billion dollars a year in ineffective, un-useful care that hurts people.

You wanna continue to throw money at a wasteful, fragmented, uncoordinated system that doesn’t reward prevention, but focuses on treating sickness after the horse is out of the barn. You wanna do that with public money, bankrupt the country, and put an economic vise on us. How about this? How about we address pharmaceutical drug costs by negotiating more aggressively, reforming patents. How about we address hospital and physician waste by really, really looking at what works. What works? Really good preventative primary care. The data seems to show that if you have good primary care everything else will follow. So spend money on that. Make it competitive. You can use out of pocket money, you can use government money, you can make it a flat fee. There’s a million ways to do it, but focus on what works. Pay doctors to keep people well instead of just reacting when they’re sick.

You fix primary care, you actually improve the rest of the system, you pay for it with a fundamental government catastrophic insurance, and what I mean is it’s actually insurance. You use it in a catastrophe. Everything else, for prevention, for your oil changes, for your tire rotations, is either out of pocket or it can be subsidized by your employer or subsidized by the government if you’re really poor. Everybody’s covered. You focus on prevention. More people go into primary care. You have better outcomes instead of the worst outcomes in the developed world for the most money. You cover it all for less. Employers have a role, competition in existing insurance companies and existing healthcare organizations has a role. Quality is what you’re paying for. It’s price transparent so it’s true competition. And you know what, that is as American as it gets. And if I were running for president, that’s what I’d try to sell you, and you would never vote for me because I tell you the truth.

But you know what, we on the front lines know that this is the way you fix medicine. So the next time you listen to a politician tell you that they’re gonna fix medicine, really think about what that means. Who’s gonna do it? Us. All of us together from the ground up. We can do it. They can never tell us how to do it. So wake up guys. Share this video. Leave a comment about what you think. If you want, become a subscriber on YouTube and Facebook and a supporter. I don’t care about that. I care about your voice being heard. Together we can actually do it. All right guys, I’m out. Peace.

– [Tom] ZDogg 2020.

– I won’t do that, Tom, that sounds horrible. Plus, there’s a lot of stuff in my closet you don’t wanna know. Of course now that Trump’s president I can probably pull it off. All right, I’m running for president. I just announced. Okay news. You’re welcome.