January 22, 2025 • 32 mins
This episode explores the staggering costs of healthcare in the U.S., We share personal stories, systemic issues, and comparisons to international healthcare systems. We emphasize the need for reform and invite listeners to consider their own experiences while advocating for a more equitable healthcare model.
• Understanding the shocking costs of common medical services
• Sharing personal stories about high medical bills
• Exploring the impact of insurance companies on healthcare pricing
• Explaining the concept of the charge master and its effects
• Comparing U.S. healthcare to systems in other countries
• Discussing the focus on reactive vs. preventative healthcare
• Addressing the ties between employment and healthcare stability
• Proposing a blend of public and private healthcare solutions
• Highlighting the importance of raising awareness for healthcare reform
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Cesar (00:00):
Today we're diving into a topic that affects every single
one of us healthcare.
$40 for an aspirin or $3,000for an ambulance ride.
How did we get here and, moreimportantly, how do they even
come up with these prices?
Why does an MRI cost as much asa round trip flight to Europe?
I'm not dumb, but why ishealthcare in the US so
expensive?
(00:20):
Welcome to the I'm not dumb butpodcast, where we won't claim
to have the answers to life'sdeepest questions but we'll give
you an exciting journey intothe realms of knowledge you
never knew you'd either.
Might be mainstream, but notcommon knowledge.
From artificial intelligence toconspiracy theories, no topic
is too taboo for us to explore.
Let's get curious together.
I'm your host, cesar, joined byChris, yo, rob, yellow and
(00:46):
Victor.
How y'all doing what's?
Rob (00:49):
up fellas.
What is going on?
I just paid a $50 copay, that'sit.
Victor (00:55):
I thought that was a lot , you guys rich, so should I
stop using an ambulance as anUber.
Cesar (01:00):
If you can afford an ambulance as an Uber, you're a
baller.
Victor (01:03):
I think I remember listening to this on a TikTok
recently that if you have to getmedevaced like they have to
send a helicopter to come getyou and bring you to a hospital.
That's like 50 grand Crazy.
Rob (01:18):
Well, the fuel pilots, their salaries are pretty high,
yeah.
Then there's the annualcertifications on those planes.
I get that 50 grand.
That's like taking a blade, man.
You should just take a blade atthat point.
Yeah, where are you going, jfk?
Victor (01:37):
I don't think a blade picks you up wherever I think
you have to go to.
Rob (01:41):
You got to meet it there, so just take an Uber to the
blade.
Well, they an Uber to the Blade.
Cesar (01:45):
Well, they're going to charge you congestion pricing
now.
Oh, yeah, it's not worth it.
Then, yeah, it's not worth it,might as well die $9?
.
Victor (01:52):
Are you kidding me?
To take a helicopter ride?
They're trying to just hurt theworking man.
Chris (01:56):
They're going to rob you.
Cesar (01:57):
They're trying to just squeeze the middle class.
Victor (02:00):
Well, come on in this economy.
Cesar (02:02):
Wait, what are we talking about again?
Healthcare.
You guys have any crazyhealthcare cost stories.
Victor (02:07):
Yeah, I just avoid going to the doctor.
That's one way to do it.
That's one way to save a lot ofmoney.
I eat an apple a day and thatusually keeps away the doctors.
Cesar (02:20):
I still don't understand why they say that I don't know
either.
I have no idea.
Chris (02:24):
Because it doesn't make any sense.
I have a pretty interestingstory about healthcare.
All right, let's hear it, Chris.
Victor (02:28):
Hold on, hold on, Before we do this.
Shut the fuck up, Chris.
Chris (02:32):
I didn't even say anything.
Victor (02:34):
It originated in Wales in the 1860s.
The original version of thephrase was eat an apple on going
to bed and you'll keep thedoctor from earning his bread.
Oh shit, that sounds prettymodern.
The phrase became popularbecause of the belief that
eating apples regularly canmaintain good health.
(02:55):
The concept of apples havinghealth benefits is not new.
Ancient Romans, anglo-saxonshave all recognized their
healthful properties.
Rob (03:04):
Well, there's probably a lot of nutrients.
There's a little caffeine getsyou going, wakes you up in the
morning.
There's no caffeine in apples.
There's caffeine in apples.
Victor (03:11):
Oh, there is.
Wait what?
Yeah, there is.
Are you jujoling it?
There's no caffeine in apples.
I don't need to jujol it.
All right, let's Google it.
Rob (03:20):
There's zero caffeine in apples.
Okay, good talk.
Cesar (03:30):
Chris, what's your story?
Chris (03:31):
man, it was like at least 10 years ago.
We went to the hospital for acheckup or something and they
told me that it wasn't coveredby the insurance, so I had to
pay out of my pocket right, Idon't remember how much it was,
but so I paid.
And then a month later I got abill of summary saying that they
put it through the insurance toget it reimbursed.
So they were like kind ofdouble dipping.
(03:51):
So I called them up and thenthey were like oh, I don't know
what you're talking about.
They're like well, you guyssaid that this isn't covered, so
I pay out of pocket, andthey're like denying everything.
And then, soon as I said theword fraud came up, their whole
attitude changed.
I'll work with you, let'sfigure out what's going on.
And then we literally wentthrough the entire process of
(04:14):
getting my money back.
Rob (04:15):
How much did they charge?
Chris (04:16):
you Like, almost like a grand.
Rob (04:18):
Wow, it's all the bills that come in after, like when I
got my shoulder surgery that Ithink the surgery was like 60
grand or something like that 70grand and then for months I just
kept getting bills mri copay,then the person who reads the
mri right x-rays person whoreads the x-rays all of a sudden
it's like three blood teststhat I got like four months ago.
(04:41):
I'm'm getting bills for that.
You just get hit every month,every month, and that wasn't
even anything.
My insurance covered it.
God forbid, I was sick.
Cesar (04:50):
They say medical debt is the highest reason for personal
bankruptcies.
All this is crazy.
Victor (04:55):
All this is crazy.
Cesar (04:56):
Take it up, take it over, no seriously the US St Luigi,
where are you?
Victor (05:03):
Come save us.
Cesar (05:04):
Too soon, bro, too soon.
The US spends significantlymore on health care compared to
any other nations, and we don'thave better health outcomes.
Victor (05:15):
No, we have better health care.
Better health care but mightnot have better outcomes.
No, we have better health care.
We don't want to let thosecommie fucking systems in here
because they're going to destroyour health care system of a
bunch of people that can't getit.
Chris (05:29):
This is.
Rob (05:29):
America, you dumb son of a bitch.
Okay, I was talking to somebodysome family members and they
were out in Europe when Idislocated my shoulder.
I had a surgery appointment inthree weeks.
I had a friend who broke hisarm out there.
He couldn't get to a doctor forthree months.
And one of my aunt's familylives out in like Germany or
(05:52):
something and they had a friendwho had a brain tumor.
They couldn't get a thing forlike a year and they ended up
just dying because they couldnever get the surgery.
They waited like six monthstill they got to this top of the
list.
Then they re-evaluate you.
Then they say, well, yourcondition has gotten so worse
because now you've developed allthese other ailments like high
(06:14):
blood pressure or whatever it is, you have to get re-evaluated.
Then you go to the bottom ofthe list and then you got to
wait again and it's like anightmare to get anything done
and a lot of like specialty,like surgeries.
I guess people come to the USto get because the doctors make
a lot of money here so that wehave a lot of specialists as
(06:34):
opposed to like basic types ofmedicine, I guess.
But yeah, I'm all for gettingpeople like covered and help,
but I also like to get seenquick.
Cesar (06:43):
No, no, no, it's true, a lot of those countries that do
have that universal healthcare.
That's one of the issues.
And in terms of specialists thespecialists in those countries
they're capped at a certainamount that they can bill or
they can charge for the year.
So let's say, like a cardiacsurgeon, right, he's supposed to
charge up to 500,000.
If, like, in June, he's at thatcap, well then, he takes the
(07:05):
rest of the year off.
Wait, what, what?
I don't know if that's ahundred percent true.
So they do those countries dohave better access because
everyone's covered.
But there's also deficiencieswith those systems, just like
here, our system is based basedon private and public, so we
have our employer sponsoredinsurance plans, our private
(07:28):
insurance companies and then theprivately owned healthcare
providers.
Then you've got the publicsector, who provides programs
such as Medicare, medicaid.
But our system is based on thishas like a fragment, so it
causes a confusing web and thisleads to a lack of care,
redundant services, delays andinefficiencies.
So there's issues with oursystem and with that one you
(07:52):
just mentioned.
We all know where the majorplayers in the healthcare system
are right.
We got the insurance companiesdetermining coverages and
negotiating costs.
We got the pharmaceuticalcompanies that develop and sell
medication at high pricesbecause of minimal regulation.
We got the hospital andhealthcare providers, some of
which are operating as anonprofit and some of which are
(08:13):
operating for profit.
And you got the patients, someof which have insurance, others
that are underinsured, othersthat don't have insurance at all
, and a whole host of you knowpatients with chronic conditions
(08:34):
.
All of this is just aclusterfuck as to what's driving
healthcare costs.
So what do you guys think aresome of the major reasons?
Costs are so high.
They can charge whatever theywant.
You're talking aboutpharmaceutical companies or
hospitals, both.
Rob (08:45):
So there is no set price for things?
What do you mean?
They can charge whatever theywant.
Victor (08:51):
Who can charge?
As far as I'm aware, you can goto one hospital in one state
and they can say your shouldersurgery is going to cost $20,000
.
You go to a hospital in adifferent state, they can say
your shoulder surgery is goingto cost $20,000.
Cesar (09:04):
You go to a hospital in a different state, they can say
your shoulder will cost $50,000.
Yes, what?
There's no regulations to stop.
There's no rhyme or reason foryeah, so there's no prices on
things.
Rob (09:12):
Things don't have prices.
Cesar (09:16):
The hospitals are like technically private right.
Some of them a lot of them workunder the nonprofit umbrella,
but they still can run a revenue.
Non, some of them, a lot ofthem, work under the nonprofit
umbrella, but they still can runa revenue.
Nonprofits can make a lot ofmoney.
That's a good segue.
So how do hospitals actuallycome up with their prices?
Right, some of them use whatthey call the charge master,
which is an internal list ofprices for services, procedures,
supplies, which are usuallyoften overinflated, beyond the
(09:37):
actual cost, overinflated beyondthe actual cost.
They rarely disclose pricesupfront, which creates a lack of
transparency, and uninsured andout-of-network patients often
are charged full rates, like Imentioned earlier, the $40 for
an aspirin that costs pennies tomake, and hospitals negotiate
lower reimbursement rates withinsurers, leading to
(09:58):
inconsistent pricing for thesame procedure and leaving the
uninsured patient with thehigher costs.
They're kind of negotiatingwith the insurance companies.
There's no standard, so theycan charge whatever they want.
Rob (10:09):
So they say this is what it costs.
I have insurance, my insurancegoes over there.
They're like we're not evenpaying close to that.
Cesar (10:16):
Your insurance company is negotiating prices with the
hospital.
The hospital is telling themthis is what we're going to
charge.
The insurance company says thisis what we're going to pay the
difference in that is where theproblem is, because the hospital
is still.
Someone needs to cover thosecosts and they just push it on
to another person or another.
Let's say like.
Chris (10:38):
Medicaid to push it on to that or somebody else it is
ridiculous because they charge,you say, for a procedure for,
say like hundred thousand orsomething, and then negotiate a
price it's like five thousand.
It's a huge gap that I noticedwhen you see the bills you get
ask for a itemized bill.
Victor (10:56):
they start lowering the costs because they don't want
you to show that you used fivecotton swabs and you got charged
$20 for each swab.
Two things I think number one.
Cesar (11:09):
Another way they kind of jack up the prices.
What they do is they takeservices that make the most
money, like elective surgeries.
Victor (11:16):
So things like what Cosmetic nose job, joint
replacements, apparently, what,which is crazy?
Are you serious?
Cesar (11:21):
Yeah, it's crazy, right, as in elective surgery.
Yeah, it's crazy.
And they price them higher tosubsidize less profitable
services like the emergency roomor to take care of patients
with Medicaid or Medicare.
What a system.
Trump and Biden both put intooffice some sort of transparency
bill, so they're going to tellyou the prices of what the
(11:42):
services cost.
It's supposed to take intoeffect in 2026 or something like
that, but Merck thepharmaceutical sued them.
Nice, so we'll see what happens.
We'll see what happens.
So, yeah, that's one of thereasons why prices are crazy.
What other reasons do you guysthink so?
A large share of the UShealthcare spending goes to
(12:03):
administration, billing,insurance, insurance management,
compliance, a lot of redundantsystems and multiplayer
complexities that drive the costof a single payer system, which
tend to divert these resourcesfrom patients to administrative
costs Right now who has themodel setup.
Rob (12:22):
You know where people are seen quickly and things are
cheap and reasonable and thingsare more efficient.
Like who's running?
Who's kind of nailing it rightnow?
Is there a country that's doingit or is this a overall?
Victor (12:35):
fuck fest.
Top healthcare systems in theworld Number one Singapore.
Number two Japan.
Number three South Korea.
The United States is 69th 69.
Cesar (12:49):
69 is a good number, not bad.
Chris (12:51):
Not bad.
My cousin was telling me thatin Korea their treatment is so
good that you could go drinklunchtime.
You can go back to work rightafter.
Rob (13:00):
They fucking would.
They'd be like yo.
We got to get these people backin the office, got you?
Cesar (13:06):
Work, work, work.
Rob (13:07):
Yeah.
So I noticed growing up, a lotof my doctors growing up have
now started joining these groups.
And then every time I'll get anemail saying like, oh, this
group has now been taken over bythis group and this group, so
what is happening there?
Saying like, oh, this group hasnow been taken over by this
group and this group, so what ishappening there?
Are they consolidating allthese like smaller medical
offices, and what's the benefit?
Cesar (13:30):
of these groups, it could be two things.
It could be bigger practicesbuying out these smaller
practices, doctors retiringselling their practices, but
also, when you get it like alarge group of doctors, one
entity negotiating on behalf ofone doctor, you're going to get
most bang for your buck.
It's the same thing with a lotof these hospitals.
A lot of these larger hospitalsnow are buying out all these
(13:52):
things.
It's like an arms race.
Victor (13:54):
So the largest hospitals in the US number one, advent
Health out of Orlando.
Number two, yale New HavenHospital.
Number three is JacksonMemorial Hospital out of Miami.
So two of those are Florida.
The Mount Sinai Hospital isnumber nine in New York.
Rob (14:13):
I called my primary care physician, who I've been seeing
since I was a child, and theywere like you've been seeing a
pediatrician as a 40 year oldand he doesn't find anything
wrong with that.
Victor (14:25):
Yeah, that fire truck is way too big for him to be
sitting on.
They have the best band-aids.
Cesar (14:30):
As a kid he's like Robbie , looking good buddy.
Victor (14:35):
Look how big you are.
Rob (14:37):
Working out Dave.
Now I called my primary carephysician.
I can no longer see her becauseshe is part of a concierge
service where I have to pay $300a month to get her as like a
retainer and then go see her.
I can only see her PAs.
Cesar (14:55):
That's an escort that you're seeing Okay, that's the
wrong bill.
Rob (15:00):
I did find her on Twitter, you.
Cesar (15:00):
That's the wrong bill.
I did find her on Twitter.
You're looking at a wrong bill,so did?
Chris (15:03):
she just joined a group recently.
Is that what happened, or?
Victor (15:07):
What's a concierge?
Rob (15:08):
service.
Yeah, I have to pay monthly ifI want to be treated by her.
So now I have to be treated byher PAs.
Chris (15:15):
What.
Rob (15:15):
Which the best thing is is, if they have any questions,
they just go ask her the nextbut prior to this you did see
her oh yeah, for years that'scrazy for like 20 years don't
you have a one-on-one more ormore access to her with the
concierge services?
Cesar (15:28):
that's the whole thing it's.
It's like it's supposed to be,like personalized medicine, this
and that will see you wheneveryou have access to what your
doctor, whatever yeah, but Idon't go to the doctor enough to
pay $300 a month.
Victor (15:41):
Supposedly they're supposed to offer you
personalized care, direct access, expedited appointments and
coordination of care.
Shouldn't this be the norm?
If I've been seeing the samephysician for the past five
years, I should be getting allof this already.
This should be a non-starter.
Rob (15:56):
I have been getting that for years.
Victor (15:58):
Yeah, you're giving me aspirin with my name on it.
Is that what's going to bedifferent?
Rob (16:04):
I mean yeah, Ooh, you're.
Cesar (16:05):
VIP.
My doc is good and he does thatnow, but I'm not.
There's something else.
You see, a man yeah, somethingabout a female is just very
caring, bro, he's the best.
He's quick and thorough.
Are we off?
We're still talking abouthealthcare.
Rob (16:25):
Victor has a concierge service as well.
I think, yeah, my back iskilling me, yeah, my back.
Well, Jules, the funny thingabout my back is that it's
located on my cock.
Cesar (16:35):
Another reason why healthcare in the US is so
expensive is our healthcaresystem is more focused on
reactive versus preventativecare.
I think the system prioritizesthat's terrible, like.
Ultimately, healthcare is abusiness right.
Unfortunately.
Victor (16:49):
Yeah, but I don't want to get sick.
I don't want to already go tothe doctor and be like listen,
I'm dying, Fix me.
Rob (16:57):
The worst part about being sick is being poor and sick,
fucking sucks.
Victor (17:02):
I'm not a fucking car Like.
I don't want to break down andthen go to my mechanic and go
listen, you need to fix this.
I don't want my car to break atall.
Rob (17:11):
Well, the thing is, if you sign up, for the concierge
service, then you could gomonthly.
Oh, really at all.
Well, the thing is, if you signup for the concierge service,
then you could go monthlywhenever you need to go.
So if you're making it part ofyour routine.
But the problem is, are youreally going to a doctor that
much, Especially at our age?
You know, like a lot of youngpeople don't go.
Victor (17:25):
I do my annual physical and if I don't need to go for
anything else, I don't go.
Cesar (17:29):
Yeah, we talked about like three or four different
topics.
That all are included.
Right, our healthcare system isfocused on reacting and not
actually preventing.
There's a whole host of socialdeterminants in healthcare
factors like housing, education,income, food access, a whole
bunch of poverty, incomeinequality a whole bunch of shit
(17:50):
that just drives the price ofhealthcare.
And let's say you don't havehealth insurance, the hospital
is still going to get theirmoney somehow some way.
What are they going to do?
Chris (17:59):
They're going to pass on the cost to someone who can't
pay.
It's crazy, because I was inthe hospital a few years ago and
I was checking in and there wasa lady next to me and she was
also checking in and they weretelling her if you don't have
insurance, the cost will be 50bucks.
And then I looked at my billand it was 150 bucks, but I had
insurance, so they're chargingme more.
Cesar (18:15):
Because they're charging their insurance company more.
Rob (18:17):
Because you can afford it.
I walked in to my doctor acouple months ago.
I was like I'm not feeling well.
She looked at my insurance.
She goes oh, you have greatinsurance.
I took every test, every bloodtest.
I walked out of there depleted,depleted, and then you know
what they did.
You're going to need to comeback in about five weeks.
(18:38):
We got to just run the numbersagain.
Victor (18:40):
She went in Before everyone starts voting
Republican.
With your insurance, youprobably go to the doctor more
than this person withoutinsurance so as they're going to
the hospital as the last resort, because they're already fucked
and they have nowhere else togo.
You go to the hospital as thelast resort because they're
already fucked and they havenowhere else to go.
You go to the doctorsemi-regularly, which is a good
(19:01):
thing which is a good thing andyou can figure out these
problems before they turn intosomething that forces you to be
hospitalized just before peoplestart, you know, jumping on the
fucking red wave after listeningfor that fucking caesar's like
going.
Why is?
Why is the flag at half?
Cesar (19:18):
max.
Yeah, why is it?
Chris (19:19):
Why isn't the flag at half max, my fucking president
just got in.
Rob (19:22):
We're going to win so much you may even get tired of
winning.
Cesar (19:26):
I'm so lost.
What's going on in the politics?
I'm so lost.
But it is true he has greathealth care and they start
testing all these things.
And it's one of the issues highcost interventions.
You know the US healthcarerelies heavily on expensive
treatment sometimes andpharmaceuticals often, without
corresponding improvement inoutcomes.
We're over medicalized andsometimes unnecessary testing of
(19:48):
procedures increases costswithout significant health
benefits.
It's another reason whyhealthcare is so expensive.
Rob (19:54):
So there's really just no way in our current system to
bring this down.
Victor (19:58):
I'll be honest, I don't think anyone wants to, besides
the people that are using thehealthcare.
I don't think anyone wants tobring it down.
There's no lawmaker that wantsto bring it down.
Rob (20:05):
I mean, if you got to do that, then a lot of these
businesses aren't going to makemoney.
As long as I'm getting thetreatment I need and I'm only
just shelling out a few co-pays,I'm cool with it.
Charge $400 million If myinsurance is covering it.
Victor (20:20):
I'm good, Rich white guy .
You have a stable job thatgives you that kind of
flexibility of like well, aslong as my health insurance is
covering it, I'm good.
There's people that move arounda lot 1099.
Right, there's people that ownsmall businesses that don't have
that kind of health insurance.
1099.
Right, there's people that ownsmall businesses that don't have
that kind of health insurance.
There's just like this huge gapof people that go to the doctor
(20:41):
and the people don't look attheir card and go, wow, you have
great health insurance, youknow.
Cesar (20:45):
And like.
Look, inflation has been on therise for like on average 2%,
right?
The cost of healthcareincreases on average 3% every
year, so it's outpacinginflation every single year, so
it's never going to go down.
And our country's getting older.
As the share of the USpopulation age 65 and over
increases, more and more peopleare going to go into Medicare,
(21:09):
and Medicare is one of thosethings where it will only pay a
certain percentage of the costs.
You got a lot of businesses ora lot of doctor's offices or a
lot of hospitals finding otherways to recoup that money
Another reason why healthcare isincreasing and will continue to
increase every year, do we?
Rob (21:29):
solve healthcare at the end of this episode, like
single-handedly figure it out.
Victor (21:33):
No, Again you're coming up with depressing fucking
episodes Bro.
Rob (21:39):
Just give me a story, just give me a story, give me some
hope.
Cesar (21:42):
Give me a funny story, doesn't matter.
What are we supposed to behappy every episode?
Yeah, no, I knew you were goingto say this too.
I knew you were going to saythis, this is healthcare.
Chris (22:01):
Healthcare-y.
Say this too.
I knew you were gonna say thisis health care, health care.
As I was doing it, I'm likethis guy's a fucking bitch.
I could blame.
Rob (22:04):
I know right what a fucking downer.
You know your episode is good.
It wins when victor shit on it.
Hater's gonna hate.
It's a lot of info but I can'trelate to all of it, so I need a
story.
Victor (22:13):
He doesn't know what poor people problems are.
Rob (22:18):
What do you mean that I can't?
Victor (22:19):
What's a poor person?
Rob (22:21):
It's like I honestly don't really know.
I never know Hide the moneyy'all, there's poor people
around.
I thought we were going to walkaway here with a clear
understanding and be like thisis what you got to do.
Cesar (22:32):
I'm Debbie Downer today, we can't donate or do something
Okay.
Rob (22:37):
Healthcare we can't do.
Victor (22:38):
We can't do healthcare Space lasers, though Come back
to it.
Rob (22:43):
Chad GPT.
You got a great idea on spacelasers.
We've been mulling that overfor a while, yeah.
Cesar (22:48):
It's just, it's expensive and it's going to continue to
be more expensive, no matterwhat.
Rob (22:57):
You got to be more expensive, no matter what.
You got to be rich or you gotto get a good job or you got to
not get sick.
I'm in Costa Rica, right, I gotsick out there, terrible
stomach problem.
So they take me to the doctor.
I'm there for hours.
I'm there for hours.
They're hitting me with IV,they're hitting me with this.
They can't figure out what'sgoing on.
I'm having stomach spasms,whatever.
I'm walking out of there I'mbeat up and the little girl
behind the register is like, andshe looks at me and the look on
(23:20):
her face I was like, oh my God,I'm going to spend a thousand
dollars right now.
Like, seriously, she goes, it'sgoing to be $74.
I was like, oh my God, this isamazing.
I've been here for hours.
I was in that hospital longerthan I was in my hotel room and
it cost me $74.
What kind of healthcare do theyhave?
Victor (23:40):
Costa Rica's healthcare system is 36th in the world.
Rob (23:43):
It's way better than ours.
Oh, wow Okay.
Victor (23:49):
Well, there you have it.
Costa Rica is known for itsaffordable and high-quality
healthcare system.
It includes both public andprivate options.
Cesar (23:55):
That sounds good.
Victor (23:56):
Couldn't we do a public slash private healthcare system
where we still have privatehealth insurance that you have
to get through your employer orsomething, but it's only for
specializations and anythingthat's just basic care or like
routine visits or prevent healthcare be completely government
(24:19):
funded?
Wouldn't that system kind ofwork?
A?
Cesar (24:21):
basic health care system.
Isn't that what Obamacare?
Victor (24:25):
is the exchanges.
That's just another healthinsurance option.
That's just an overall healthinsurance, but for more
affordable, like a public system.
Cesar (24:34):
I think it started out as something completely different.
Victor (24:36):
Yes, the whole Affordable Care Act was supposed
to be.
Everyone contributes anddepending on your age, you
contribute a different amount.
So the older you get, the lessyou contribute, because it'll be
more beneficial to you whenyou're older rather than when
you're younger, when you're notgoing to the doctor.
Cesar (24:51):
And you still have private, you still have your
private insurance.
Victor (24:56):
I'm talking about you still have private.
You still have your privateinsurance.
I'm talking about you stillhave private insurance.
But like anytime you go seeyour primary care doctor, you're
paying nothing, no copay,you're not even going through
insurance.
You just show up there or youmake your appointment and it's
all covered for you.
But your specializations,that's what your insurance kicks
in for.
Isn't that the best?
Cesar (25:12):
of both worlds.
So the government wouldsubsidize primary care.
Yeah.
Rob (25:16):
And preventative care.
It would be cheaper for theinsurance companies.
They don't have to cover asmuch if people are going to a
doctor more.
Victor (25:20):
Theoretically, you need a specialist less than you need
your primary care.
Just figured it out.
Aoc, hit me the fuck up.
We have concepts of a plan thatwould be better.
Rob (25:30):
And this is how we're going to pay for it, right you?
How we're gonna pay for it,right you gotta tax it casinos
in the hospitals downstairs.
Cesar (25:40):
All the losses will cover all the old people.
Rob (25:42):
They're already in there, they're in there hey wait,
wasn't it idiocracy?
Chris (25:44):
wasn't there um casino thing like slot machine in the
hospital?
Rob (25:47):
that's what we need to cover this aoc, hit me up.
Victor (25:51):
I got a plan for you, yeah I don't think that.
I don't think that will pass,just because, like I don't think
it'll, but I think that wouldbe the best approach that would
be beneficial to everybody.
I want my money.
Cesar (26:02):
as a doctor, you're going to have less people going to
primary care.
You're going to get your money.
Victor (26:05):
You're going to get your money.
Rob (26:06):
They're going to cap it, you're going to get your money.
Victor (26:08):
What do you?
Rob (26:09):
mean Salaries.
Victor (26:16):
Yeah, is it'll force doctors to take on more patients
.
Not specialized, onlyspecialized won't have to cap it
.
No, I'm talking about primarycare.
Cesar (26:19):
You're talking about everybody.
Primary care will be subsidizedby the government, right?
So they're going to have to capit at a certain price, at a
certain salary.
Victor (26:25):
But that's already.
That's already.
First of all, it's already hardto find primary care physicians
, but at least they'll be freeand not anyone's issue.
But at least they'll be freeand not anyone's issue.
And if you can avoid seeingthat specialist, even better,
Because now you're getting thatkind of preventative hair.
Cesar (26:41):
Specialists are going to be pissed.
It's hard to get an appointmentnow.
It's crazy.
Victor (26:43):
They're going to be pissed Because they can charge
so much?
Why Cancer's not going away.
Rob (26:48):
But don't you have to go to the primary care to get.
If you go to a lot of these,specialists like urgent care.
Cesar (26:55):
They're just doing a bare minimum and they're just
passing you on to somebody else.
Victor (27:00):
That's all everybody needs.
Really Number one, that'surgent care.
But that's what urgent care isfor.
It's like the basic and get thefuck out.
Because even if you go tourgent care and you have a
serious emergency, they say goto the ER.
Oh really, yeah.
They tell you they're likelisten, we can't shoot you,
you're bleeding out of yourasshole.
You need to go to the ER.
All right world hunger, let'ssolve that.
(27:22):
It's not a bad idea.
I think victory Thank you whata good one.
Rob (27:25):
Too good, too good, too good, too good.
Cesar (27:37):
Might be a habit's time.
Yeah, they're listening in.
United health care is about toget its revenge on you.
Chris (27:39):
I will find you the part that gets me is that, like the
uh evaluation or whatnot,whatever we call it like even my
co-worker, like he said thathis daughter had a heart issue
and then they were going forlike a surgery or something like
that, they have to get likestatements and letters to show
proof that their daughter'sgonna to die.
If I don't get this, it waslike I don't know.
Cesar (28:00):
I don't know if you've seen the memes about the
insurance companies.
The insurance companies are outto basically reject and deny
anything you need them to pay.
Chris (28:10):
It's such a bullshit and I remember my coworker being
super worried.
He was like yo I don't know ifthey're going to reject this.
I don't know what's going tohappen.
Rob (28:19):
Don't they have AI chatbots that are designed to deny so
many percentage of claims orsomething like that?
Unitedhealthcare had that An AIthat was denying 90% of claims
and it was off and they knew it,but they let it run anyway.
Cesar (28:35):
Crazy times, anyway, healthcare Expensive, chris.
What'd you learn today, man?
Chris (28:39):
Like I never from the beginning, like I knew it was a
bullshit because of all the.
It's difficult and it's veryconfusing and it's I don't know,
it's a topic.
It's very uneasy too.
So it's like I have mixedfeelings about healthcare.
But sometimes I do feel bad forpeople that can't afford it or
(28:59):
don't have really nice ones, youknow, because I know what they
have to go through, because evenlike a little thing that
happens to me, that I always getpissed off and it takes a lot
of time just to resolve it and Ican't imagine what people have
to go through a daily basis.
To you know that people, eventhey, can't afford to do it.
Cesar (29:13):
So yeah, Victor, what about you, man?
Victor (29:16):
What about you, man?
I don't understand how we as acountry who love to talk about
our freedoms and our rights, andlove to talk about how
important our freedom of speechis, our freedom to bear arms,
but for somehow we missed thefreedom to be healthy, like as a
God given right, as if that'ssomething that should be for
(29:37):
profit or should be exploited.
That being said, I solved thehealthcare problem, so you know.
Rob (29:45):
Rob, it just seems that the way you explained it I mean
healthcare just is incrediblyconfusing.
It seems like there's so manyhands on the pot.
For it to have change, peoplehave to really care about it.
A lot of people have.
There's a lot of rich people,there's a lot of people who have
jobs that cover this type ofthing, and you're only really
(30:05):
going to hear about the peoplewho can afford it, and the young
don't even care.
So you know you have a smallamount of people who are really
getting hurt by these things.
And then the outliers, whereyou know the major cases where
you hear you know someone hascancer or something like that,
and then they're completelybankrupt these terrible stories.
But it's a confusing thing.
(30:25):
I don't even read my explanationof benefits.
I don't even look into thistype of stuff.
I go to the doctor.
They tell me it's 20 bucks.
I pay it.
I go the next week.
It's 25.
I'm like, okay, the prices wentup.
I don't even know how it works.
So I think majority of peopleprobably think that way too, and
if it's too confusing, they'reprobably really not looking into
it.
Either you got to set yourselfup or you got to be lucky enough
(30:48):
to have yourself set up to getthrough this, because you know
when you're young you don't eventhink about it.
As you get older, you knowyou're going to doctor a lot
more.
Chris (30:56):
There are people in this country where they're miserable
and they hate their job butbecause of the health care they
can't leave.
They're kind of like buying tothe job they're called public
sector workers.
Victor (31:11):
How crazy is that?
That we have something in ourConstitution that allows the
pursuit of happiness but we arestuck with jobs because of
health insurance.
That's the biggest.
One of the biggest limiters offreedom there is the fact that
it's tied to your job.
Cesar (31:27):
Oh yeah you're in prison at that point.
So there you have it A deepdive into why healthcare in the
US is so expensive.
From the insurance negotiationsto the inflated prices and the
lack of regulation, it's clearthat the system is complex, but
the stakes are incredibly high.
If you enjoyed today's show,hit that follow button and
spread the word of this amazingpodcast you've discovered.
(31:48):
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you have a question, suggestionor just want to share your
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We want to hear from you.
Find us on Twitter at I'm NotDumb but, and on YouTube at I'm
not dumb but podcast.
Until next time, Remember, staycurious.
Today we're diving into a topic that affects every single
one of us healthcare.
$40 for an aspirin or $3,000for an ambulance ride.
How did we get here and, moreimportantly, how do they even
come up with these prices?
Why does an MRI cost as much asa round trip flight to Europe?
I'm not dumb, but why ishealthcare in the US so
expensive?
(00:20):
Welcome to the I'm not dumb butpodcast, where we won't claim
to have the answers to life'sdeepest questions but we'll give
you an exciting journey intothe realms of knowledge you
never knew you'd either.
Might be mainstream, but notcommon knowledge.
From artificial intelligence toconspiracy theories, no topic
is too taboo for us to explore.
Let's get curious together.
I'm your host, cesar, joined byChris, yo, rob, yellow and
(00:46):
Victor.
How y'all doing what's?
Rob (00:49):
up fellas.
What is going on?
I just paid a $50 copay, that'sit.
Victor (00:55):
I thought that was a lot , you guys rich, so should I
stop using an ambulance as anUber.
Cesar (01:00):
If you can afford an ambulance as an Uber, you're a
baller.
Victor (01:03):
I think I remember listening to this on a TikTok
recently that if you have to getmedevaced like they have to
send a helicopter to come getyou and bring you to a hospital.
That's like 50 grand Crazy.
Rob (01:18):
Well, the fuel pilots, their salaries are pretty high,
yeah.
Then there's the annualcertifications on those planes.
I get that 50 grand.
That's like taking a blade, man.
You should just take a blade atthat point.
Yeah, where are you going, jfk?
Victor (01:37):
I don't think a blade picks you up wherever I think
you have to go to.
Rob (01:41):
You got to meet it there, so just take an Uber to the
blade.
Well, they an Uber to the Blade.
Cesar (01:45):
Well, they're going to charge you congestion pricing
now.
Oh, yeah, it's not worth it.
Then, yeah, it's not worth it,might as well die $9?
.
Victor (01:52):
Are you kidding me?
To take a helicopter ride?
They're trying to just hurt theworking man.
Chris (01:56):
They're going to rob you.
Cesar (01:57):
They're trying to just squeeze the middle class.
Victor (02:00):
Well, come on in this economy.
Cesar (02:02):
Wait, what are we talking about again?
Healthcare.
You guys have any crazyhealthcare cost stories.
Victor (02:07):
Yeah, I just avoid going to the doctor.
That's one way to do it.
That's one way to save a lot ofmoney.
I eat an apple a day and thatusually keeps away the doctors.
Cesar (02:20):
I still don't understand why they say that I don't know
either.
I have no idea.
Chris (02:24):
Because it doesn't make any sense.
I have a pretty interestingstory about healthcare.
All right, let's hear it, Chris.
Victor (02:28):
Hold on, hold on, Before we do this.
Shut the fuck up, Chris.
Chris (02:32):
I didn't even say anything.
Victor (02:34):
It originated in Wales in the 1860s.
The original version of thephrase was eat an apple on going
to bed and you'll keep thedoctor from earning his bread.
Oh shit, that sounds prettymodern.
The phrase became popularbecause of the belief that
eating apples regularly canmaintain good health.
(02:55):
The concept of apples havinghealth benefits is not new.
Ancient Romans, anglo-saxonshave all recognized their
healthful properties.
Rob (03:04):
Well, there's probably a lot of nutrients.
There's a little caffeine getsyou going, wakes you up in the
morning.
There's no caffeine in apples.
There's caffeine in apples.
Victor (03:11):
Oh, there is.
Wait what?
Yeah, there is.
Are you jujoling it?
There's no caffeine in apples.
I don't need to jujol it.
All right, let's Google it.
Rob (03:20):
There's zero caffeine in apples.
Okay, good talk.
Cesar (03:30):
Chris, what's your story?
Chris (03:31):
man, it was like at least 10 years ago.
We went to the hospital for acheckup or something and they
told me that it wasn't coveredby the insurance, so I had to
pay out of my pocket right, Idon't remember how much it was,
but so I paid.
And then a month later I got abill of summary saying that they
put it through the insurance toget it reimbursed.
So they were like kind ofdouble dipping.
(03:51):
So I called them up and thenthey were like oh, I don't know
what you're talking about.
They're like well, you guyssaid that this isn't covered, so
I pay out of pocket, andthey're like denying everything.
And then, soon as I said theword fraud came up, their whole
attitude changed.
I'll work with you, let'sfigure out what's going on.
And then we literally wentthrough the entire process of
(04:14):
getting my money back.
Rob (04:15):
How much did they charge?
Chris (04:16):
you Like, almost like a grand.
Rob (04:18):
Wow, it's all the bills that come in after, like when I
got my shoulder surgery that Ithink the surgery was like 60
grand or something like that 70grand and then for months I just
kept getting bills mri copay,then the person who reads the
mri right x-rays person whoreads the x-rays all of a sudden
it's like three blood teststhat I got like four months ago.
(04:41):
I'm'm getting bills for that.
You just get hit every month,every month, and that wasn't
even anything.
My insurance covered it.
God forbid, I was sick.
Cesar (04:50):
They say medical debt is the highest reason for personal
bankruptcies.
All this is crazy.
Victor (04:55):
All this is crazy.
Cesar (04:56):
Take it up, take it over, no seriously the US St Luigi,
where are you?
Victor (05:03):
Come save us.
Cesar (05:04):
Too soon, bro, too soon.
The US spends significantlymore on health care compared to
any other nations, and we don'thave better health outcomes.
Victor (05:15):
No, we have better health care.
Better health care but mightnot have better outcomes.
No, we have better health care.
We don't want to let thosecommie fucking systems in here
because they're going to destroyour health care system of a
bunch of people that can't getit.
Chris (05:29):
This is.
Rob (05:29):
America, you dumb son of a bitch.
Okay, I was talking to somebodysome family members and they
were out in Europe when Idislocated my shoulder.
I had a surgery appointment inthree weeks.
I had a friend who broke hisarm out there.
He couldn't get to a doctor forthree months.
And one of my aunt's familylives out in like Germany or
(05:52):
something and they had a friendwho had a brain tumor.
They couldn't get a thing forlike a year and they ended up
just dying because they couldnever get the surgery.
They waited like six monthstill they got to this top of the
list.
Then they re-evaluate you.
Then they say, well, yourcondition has gotten so worse
because now you've developed allthese other ailments like high
(06:14):
blood pressure or whatever it is, you have to get re-evaluated.
Then you go to the bottom ofthe list and then you got to
wait again and it's like anightmare to get anything done
and a lot of like specialty,like surgeries.
I guess people come to the USto get because the doctors make
a lot of money here so that wehave a lot of specialists as
(06:34):
opposed to like basic types ofmedicine, I guess.
But yeah, I'm all for gettingpeople like covered and help,
but I also like to get seenquick.
Cesar (06:43):
No, no, no, it's true, a lot of those countries that do
have that universal healthcare.
That's one of the issues.
And in terms of specialists thespecialists in those countries
they're capped at a certainamount that they can bill or
they can charge for the year.
So let's say, like a cardiacsurgeon, right, he's supposed to
charge up to 500,000.
If, like, in June, he's at thatcap, well then, he takes the
(07:05):
rest of the year off.
Wait, what, what?
I don't know if that's ahundred percent true.
So they do those countries dohave better access because
everyone's covered.
But there's also deficiencieswith those systems, just like
here, our system is based basedon private and public, so we
have our employer sponsoredinsurance plans, our private
(07:28):
insurance companies and then theprivately owned healthcare
providers.
Then you've got the publicsector, who provides programs
such as Medicare, medicaid.
But our system is based on thishas like a fragment, so it
causes a confusing web and thisleads to a lack of care,
redundant services, delays andinefficiencies.
So there's issues with oursystem and with that one you
(07:52):
just mentioned.
We all know where the majorplayers in the healthcare system
are right.
We got the insurance companiesdetermining coverages and
negotiating costs.
We got the pharmaceuticalcompanies that develop and sell
medication at high pricesbecause of minimal regulation.
We got the hospital andhealthcare providers, some of
which are operating as anonprofit and some of which are
(08:13):
operating for profit.
And you got the patients, someof which have insurance, others
that are underinsured, othersthat don't have insurance at all
, and a whole host of you knowpatients with chronic conditions
(08:34):
.
All of this is just aclusterfuck as to what's driving
healthcare costs.
So what do you guys think aresome of the major reasons?
Costs are so high.
They can charge whatever theywant.
You're talking aboutpharmaceutical companies or
hospitals, both.
Rob (08:45):
So there is no set price for things?
What do you mean?
They can charge whatever theywant.
Victor (08:51):
Who can charge?
As far as I'm aware, you can goto one hospital in one state
and they can say your shouldersurgery is going to cost $20,000
.
You go to a hospital in adifferent state, they can say
your shoulder surgery is goingto cost $20,000.
Cesar (09:04):
You go to a hospital in a different state, they can say
your shoulder will cost $50,000.
Yes, what?
There's no regulations to stop.
There's no rhyme or reason foryeah, so there's no prices on
things.
Rob (09:12):
Things don't have prices.
Cesar (09:16):
The hospitals are like technically private right.
Some of them a lot of them workunder the nonprofit umbrella,
but they still can run a revenue.
Non, some of them, a lot ofthem, work under the nonprofit
umbrella, but they still can runa revenue.
Nonprofits can make a lot ofmoney.
That's a good segue.
So how do hospitals actuallycome up with their prices?
Right, some of them use whatthey call the charge master,
which is an internal list ofprices for services, procedures,
supplies, which are usuallyoften overinflated, beyond the
(09:37):
actual cost, overinflated beyondthe actual cost.
They rarely disclose pricesupfront, which creates a lack of
transparency, and uninsured andout-of-network patients often
are charged full rates, like Imentioned earlier, the $40 for
an aspirin that costs pennies tomake, and hospitals negotiate
lower reimbursement rates withinsurers, leading to
(09:58):
inconsistent pricing for thesame procedure and leaving the
uninsured patient with thehigher costs.
They're kind of negotiatingwith the insurance companies.
There's no standard, so theycan charge whatever they want.
Rob (10:09):
So they say this is what it costs.
I have insurance, my insurancegoes over there.
They're like we're not evenpaying close to that.
Cesar (10:16):
Your insurance company is negotiating prices with the
hospital.
The hospital is telling themthis is what we're going to
charge.
The insurance company says thisis what we're going to pay the
difference in that is where theproblem is, because the hospital
is still.
Someone needs to cover thosecosts and they just push it on
to another person or another.
Let's say like.
Chris (10:38):
Medicaid to push it on to that or somebody else it is
ridiculous because they charge,you say, for a procedure for,
say like hundred thousand orsomething, and then negotiate a
price it's like five thousand.
It's a huge gap that I noticedwhen you see the bills you get
ask for a itemized bill.
Victor (10:56):
they start lowering the costs because they don't want
you to show that you used fivecotton swabs and you got charged
$20 for each swab.
Two things I think number one.
Cesar (11:09):
Another way they kind of jack up the prices.
What they do is they takeservices that make the most
money, like elective surgeries.
Victor (11:16):
So things like what Cosmetic nose job, joint
replacements, apparently, what,which is crazy?
Are you serious?
Cesar (11:21):
Yeah, it's crazy, right, as in elective surgery.
Yeah, it's crazy.
And they price them higher tosubsidize less profitable
services like the emergency roomor to take care of patients
with Medicaid or Medicare.
What a system.
Trump and Biden both put intooffice some sort of transparency
bill, so they're going to tellyou the prices of what the
(11:42):
services cost.
It's supposed to take intoeffect in 2026 or something like
that, but Merck thepharmaceutical sued them.
Nice, so we'll see what happens.
We'll see what happens.
So, yeah, that's one of thereasons why prices are crazy.
What other reasons do you guysthink so?
A large share of the UShealthcare spending goes to
(12:03):
administration, billing,insurance, insurance management,
compliance, a lot of redundantsystems and multiplayer
complexities that drive the costof a single payer system, which
tend to divert these resourcesfrom patients to administrative
costs Right now who has themodel setup.
Rob (12:22):
You know where people are seen quickly and things are
cheap and reasonable and thingsare more efficient.
Like who's running?
Who's kind of nailing it rightnow?
Is there a country that's doingit or is this a overall?
Victor (12:35):
fuck fest.
Top healthcare systems in theworld Number one Singapore.
Number two Japan.
Number three South Korea.
The United States is 69th 69.
Cesar (12:49):
69 is a good number, not bad.
Chris (12:51):
Not bad.
My cousin was telling me thatin Korea their treatment is so
good that you could go drinklunchtime.
You can go back to work rightafter.
Rob (13:00):
They fucking would.
They'd be like yo.
We got to get these people backin the office, got you?
Cesar (13:06):
Work, work, work.
Rob (13:07):
Yeah.
So I noticed growing up, a lotof my doctors growing up have
now started joining these groups.
And then every time I'll get anemail saying like, oh, this
group has now been taken over bythis group and this group, so
what is happening there?
Saying like, oh, this group hasnow been taken over by this
group and this group, so what ishappening there?
Are they consolidating allthese like smaller medical
offices, and what's the benefit?
Cesar (13:30):
of these groups, it could be two things.
It could be bigger practicesbuying out these smaller
practices, doctors retiringselling their practices, but
also, when you get it like alarge group of doctors, one
entity negotiating on behalf ofone doctor, you're going to get
most bang for your buck.
It's the same thing with a lotof these hospitals.
A lot of these larger hospitalsnow are buying out all these
(13:52):
things.
It's like an arms race.
Victor (13:54):
So the largest hospitals in the US number one, advent
Health out of Orlando.
Number two, yale New HavenHospital.
Number three is JacksonMemorial Hospital out of Miami.
So two of those are Florida.
The Mount Sinai Hospital isnumber nine in New York.
Rob (14:13):
I called my primary care physician, who I've been seeing
since I was a child, and theywere like you've been seeing a
pediatrician as a 40 year oldand he doesn't find anything
wrong with that.
Victor (14:25):
Yeah, that fire truck is way too big for him to be
sitting on.
They have the best band-aids.
Cesar (14:30):
As a kid he's like Robbie , looking good buddy.
Victor (14:35):
Look how big you are.
Rob (14:37):
Working out Dave.
Now I called my primary carephysician.
I can no longer see her becauseshe is part of a concierge
service where I have to pay $300a month to get her as like a
retainer and then go see her.
I can only see her PAs.
Cesar (14:55):
That's an escort that you're seeing Okay, that's the
wrong bill.
Rob (15:00):
I did find her on Twitter, you.
Cesar (15:00):
That's the wrong bill.
I did find her on Twitter.
You're looking at a wrong bill,so did?
Chris (15:03):
she just joined a group recently.
Is that what happened, or?
Victor (15:07):
What's a concierge?
Rob (15:08):
service.
Yeah, I have to pay monthly ifI want to be treated by her.
So now I have to be treated byher PAs.
Chris (15:15):
What.
Rob (15:15):
Which the best thing is is, if they have any questions,
they just go ask her the nextbut prior to this you did see
her oh yeah, for years that'scrazy for like 20 years don't
you have a one-on-one more ormore access to her with the
concierge services?
Cesar (15:28):
that's the whole thing it's.
It's like it's supposed to be,like personalized medicine, this
and that will see you wheneveryou have access to what your
doctor, whatever yeah, but Idon't go to the doctor enough to
pay $300 a month.
Victor (15:41):
Supposedly they're supposed to offer you
personalized care, direct access, expedited appointments and
coordination of care.
Shouldn't this be the norm?
If I've been seeing the samephysician for the past five
years, I should be getting allof this already.
This should be a non-starter.
Rob (15:56):
I have been getting that for years.
Victor (15:58):
Yeah, you're giving me aspirin with my name on it.
Is that what's going to bedifferent?
Rob (16:04):
I mean yeah, Ooh, you're.
Cesar (16:05):
VIP.
My doc is good and he does thatnow, but I'm not.
There's something else.
You see, a man yeah, somethingabout a female is just very
caring, bro, he's the best.
He's quick and thorough.
Are we off?
We're still talking abouthealthcare.
Rob (16:25):
Victor has a concierge service as well.
I think, yeah, my back iskilling me, yeah, my back.
Well, Jules, the funny thingabout my back is that it's
located on my cock.
Cesar (16:35):
Another reason why healthcare in the US is so
expensive is our healthcaresystem is more focused on
reactive versus preventativecare.
I think the system prioritizesthat's terrible, like.
Ultimately, healthcare is abusiness right.
Unfortunately.
Victor (16:49):
Yeah, but I don't want to get sick.
I don't want to already go tothe doctor and be like listen,
I'm dying, Fix me.
Rob (16:57):
The worst part about being sick is being poor and sick,
fucking sucks.
Victor (17:02):
I'm not a fucking car Like.
I don't want to break down andthen go to my mechanic and go
listen, you need to fix this.
I don't want my car to break atall.
Rob (17:11):
Well, the thing is, if you sign up, for the concierge
service, then you could gomonthly.
Oh, really at all.
Well, the thing is, if you signup for the concierge service,
then you could go monthlywhenever you need to go.
So if you're making it part ofyour routine.
But the problem is, are youreally going to a doctor that
much, Especially at our age?
You know, like a lot of youngpeople don't go.
Victor (17:25):
I do my annual physical and if I don't need to go for
anything else, I don't go.
Cesar (17:29):
Yeah, we talked about like three or four different
topics.
That all are included.
Right, our healthcare system isfocused on reacting and not
actually preventing.
There's a whole host of socialdeterminants in healthcare
factors like housing, education,income, food access, a whole
bunch of poverty, incomeinequality a whole bunch of shit
(17:50):
that just drives the price ofhealthcare.
And let's say you don't havehealth insurance, the hospital
is still going to get theirmoney somehow some way.
What are they going to do?
Chris (17:59):
They're going to pass on the cost to someone who can't
pay.
It's crazy, because I was inthe hospital a few years ago and
I was checking in and there wasa lady next to me and she was
also checking in and they weretelling her if you don't have
insurance, the cost will be 50bucks.
And then I looked at my billand it was 150 bucks, but I had
insurance, so they're chargingme more.
Cesar (18:15):
Because they're charging their insurance company more.
Rob (18:17):
Because you can afford it.
I walked in to my doctor acouple months ago.
I was like I'm not feeling well.
She looked at my insurance.
She goes oh, you have greatinsurance.
I took every test, every bloodtest.
I walked out of there depleted,depleted, and then you know
what they did.
You're going to need to comeback in about five weeks.
(18:38):
We got to just run the numbersagain.
Victor (18:40):
She went in Before everyone starts voting
Republican.
With your insurance, youprobably go to the doctor more
than this person withoutinsurance so as they're going to
the hospital as the last resort, because they're already fucked
and they have nowhere else togo.
You go to the hospital as thelast resort because they're
already fucked and they havenowhere else to go.
You go to the doctorsemi-regularly, which is a good
(19:01):
thing which is a good thing andyou can figure out these
problems before they turn intosomething that forces you to be
hospitalized just before peoplestart, you know, jumping on the
fucking red wave after listeningfor that fucking caesar's like
going.
Why is?
Why is the flag at half?
Cesar (19:18):
max.
Yeah, why is it?
Chris (19:19):
Why isn't the flag at half max, my fucking president
just got in.
Rob (19:22):
We're going to win so much you may even get tired of
winning.
Cesar (19:26):
I'm so lost.
What's going on in the politics?
I'm so lost.
But it is true he has greathealth care and they start
testing all these things.
And it's one of the issues highcost interventions.
You know the US healthcarerelies heavily on expensive
treatment sometimes andpharmaceuticals often, without
corresponding improvement inoutcomes.
We're over medicalized andsometimes unnecessary testing of
(19:48):
procedures increases costswithout significant health
benefits.
It's another reason whyhealthcare is so expensive.
Rob (19:54):
So there's really just no way in our current system to
bring this down.
Victor (19:58):
I'll be honest, I don't think anyone wants to, besides
the people that are using thehealthcare.
I don't think anyone wants tobring it down.
There's no lawmaker that wantsto bring it down.
Rob (20:05):
I mean, if you got to do that, then a lot of these
businesses aren't going to makemoney.
As long as I'm getting thetreatment I need and I'm only
just shelling out a few co-pays,I'm cool with it.
Charge $400 million If myinsurance is covering it.
Victor (20:20):
I'm good, Rich white guy .
You have a stable job thatgives you that kind of
flexibility of like well, aslong as my health insurance is
covering it, I'm good.
There's people that move arounda lot 1099.
Right, there's people that ownsmall businesses that don't have
that kind of health insurance.
1099.
Right, there's people that ownsmall businesses that don't have
that kind of health insurance.
There's just like this huge gapof people that go to the doctor
(20:41):
and the people don't look attheir card and go, wow, you have
great health insurance, youknow.
Cesar (20:45):
And like.
Look, inflation has been on therise for like on average 2%,
right?
The cost of healthcareincreases on average 3% every
year, so it's outpacinginflation every single year, so
it's never going to go down.
And our country's getting older.
As the share of the USpopulation age 65 and over
increases, more and more peopleare going to go into Medicare,
(21:09):
and Medicare is one of thosethings where it will only pay a
certain percentage of the costs.
You got a lot of businesses ora lot of doctor's offices or a
lot of hospitals finding otherways to recoup that money
Another reason why healthcare isincreasing and will continue to
increase every year, do we?
Rob (21:29):
solve healthcare at the end of this episode, like
single-handedly figure it out.
Victor (21:33):
No, Again you're coming up with depressing fucking
episodes Bro.
Rob (21:39):
Just give me a story, just give me a story, give me some
hope.
Cesar (21:42):
Give me a funny story, doesn't matter.
What are we supposed to behappy every episode?
Yeah, no, I knew you were goingto say this too.
I knew you were going to saythis, this is healthcare.
Chris (22:01):
Healthcare-y.
Say this too.
I knew you were gonna say thisis health care, health care.
As I was doing it, I'm likethis guy's a fucking bitch.
I could blame.
Rob (22:04):
I know right what a fucking downer.
You know your episode is good.
It wins when victor shit on it.
Hater's gonna hate.
It's a lot of info but I can'trelate to all of it, so I need a
story.
Victor (22:13):
He doesn't know what poor people problems are.
Rob (22:18):
What do you mean that I can't?
Victor (22:19):
What's a poor person?
Rob (22:21):
It's like I honestly don't really know.
I never know Hide the moneyy'all, there's poor people
around.
I thought we were going to walkaway here with a clear
understanding and be like thisis what you got to do.
Cesar (22:32):
I'm Debbie Downer today, we can't donate or do something
Okay.
Rob (22:37):
Healthcare we can't do.
Victor (22:38):
We can't do healthcare Space lasers, though Come back
to it.
Rob (22:43):
Chad GPT.
You got a great idea on spacelasers.
We've been mulling that overfor a while, yeah.
Cesar (22:48):
It's just, it's expensive and it's going to continue to
be more expensive, no matterwhat.
Rob (22:57):
You got to be more expensive, no matter what.
You got to be rich or you gotto get a good job or you got to
not get sick.
I'm in Costa Rica, right, I gotsick out there, terrible
stomach problem.
So they take me to the doctor.
I'm there for hours.
I'm there for hours.
They're hitting me with IV,they're hitting me with this.
They can't figure out what'sgoing on.
I'm having stomach spasms,whatever.
I'm walking out of there I'mbeat up and the little girl
behind the register is like, andshe looks at me and the look on
(23:20):
her face I was like, oh my God,I'm going to spend a thousand
dollars right now.
Like, seriously, she goes, it'sgoing to be $74.
I was like, oh my God, this isamazing.
I've been here for hours.
I was in that hospital longerthan I was in my hotel room and
it cost me $74.
What kind of healthcare do theyhave?
Victor (23:40):
Costa Rica's healthcare system is 36th in the world.
Rob (23:43):
It's way better than ours.
Oh, wow Okay.
Victor (23:49):
Well, there you have it.
Costa Rica is known for itsaffordable and high-quality
healthcare system.
It includes both public andprivate options.
Cesar (23:55):
That sounds good.
Victor (23:56):
Couldn't we do a public slash private healthcare system
where we still have privatehealth insurance that you have
to get through your employer orsomething, but it's only for
specializations and anythingthat's just basic care or like
routine visits or prevent healthcare be completely government
(24:19):
funded?
Wouldn't that system kind ofwork?
A?
Cesar (24:21):
basic health care system.
Isn't that what Obamacare?
Victor (24:25):
is the exchanges.
That's just another healthinsurance option.
That's just an overall healthinsurance, but for more
affordable, like a public system.
Cesar (24:34):
I think it started out as something completely different.
Victor (24:36):
Yes, the whole Affordable Care Act was supposed
to be.
Everyone contributes anddepending on your age, you
contribute a different amount.
So the older you get, the lessyou contribute, because it'll be
more beneficial to you whenyou're older rather than when
you're younger, when you're notgoing to the doctor.
Cesar (24:51):
And you still have private, you still have your
private insurance.
Victor (24:56):
I'm talking about you still have private.
You still have your privateinsurance.
I'm talking about you stillhave private insurance.
But like anytime you go seeyour primary care doctor, you're
paying nothing, no copay,you're not even going through
insurance.
You just show up there or youmake your appointment and it's
all covered for you.
But your specializations,that's what your insurance kicks
in for.
Isn't that the best?
Cesar (25:12):
of both worlds.
So the government wouldsubsidize primary care.
Yeah.
Rob (25:16):
And preventative care.
It would be cheaper for theinsurance companies.
They don't have to cover asmuch if people are going to a
doctor more.
Victor (25:20):
Theoretically, you need a specialist less than you need
your primary care.
Just figured it out.
Aoc, hit me the fuck up.
We have concepts of a plan thatwould be better.
Rob (25:30):
And this is how we're going to pay for it, right you?
How we're gonna pay for it,right you gotta tax it casinos
in the hospitals downstairs.
Cesar (25:40):
All the losses will cover all the old people.
Rob (25:42):
They're already in there, they're in there hey wait,
wasn't it idiocracy?
Chris (25:44):
wasn't there um casino thing like slot machine in the
hospital?
Rob (25:47):
that's what we need to cover this aoc, hit me up.
Victor (25:51):
I got a plan for you, yeah I don't think that.
I don't think that will pass,just because, like I don't think
it'll, but I think that wouldbe the best approach that would
be beneficial to everybody.
I want my money.
Cesar (26:02):
as a doctor, you're going to have less people going to
primary care.
You're going to get your money.
Victor (26:05):
You're going to get your money.
Rob (26:06):
They're going to cap it, you're going to get your money.
Victor (26:08):
What do you?
Rob (26:09):
mean Salaries.
Victor (26:16):
Yeah, is it'll force doctors to take on more patients
.
Not specialized, onlyspecialized won't have to cap it
.
No, I'm talking about primarycare.
Cesar (26:19):
You're talking about everybody.
Primary care will be subsidizedby the government, right?
So they're going to have to capit at a certain price, at a
certain salary.
Victor (26:25):
But that's already.
That's already.
First of all, it's already hardto find primary care physicians
, but at least they'll be freeand not anyone's issue.
But at least they'll be freeand not anyone's issue.
And if you can avoid seeingthat specialist, even better,
Because now you're getting thatkind of preventative hair.
Cesar (26:41):
Specialists are going to be pissed.
It's hard to get an appointmentnow.
It's crazy.
Victor (26:43):
They're going to be pissed Because they can charge
so much?
Why Cancer's not going away.
Rob (26:48):
But don't you have to go to the primary care to get.
If you go to a lot of these,specialists like urgent care.
Cesar (26:55):
They're just doing a bare minimum and they're just
passing you on to somebody else.
Victor (27:00):
That's all everybody needs.
Really Number one, that'surgent care.
But that's what urgent care isfor.
It's like the basic and get thefuck out.
Because even if you go tourgent care and you have a
serious emergency, they say goto the ER.
Oh really, yeah.
They tell you they're likelisten, we can't shoot you,
you're bleeding out of yourasshole.
You need to go to the ER.
All right world hunger, let'ssolve that.
(27:22):
It's not a bad idea.
I think victory Thank you whata good one.
Rob (27:25):
Too good, too good, too good, too good.
Cesar (27:37):
Might be a habit's time.
Yeah, they're listening in.
United health care is about toget its revenge on you.
Chris (27:39):
I will find you the part that gets me is that, like the
uh evaluation or whatnot,whatever we call it like even my
co-worker, like he said thathis daughter had a heart issue
and then they were going forlike a surgery or something like
that, they have to get likestatements and letters to show
proof that their daughter'sgonna to die.
If I don't get this, it waslike I don't know.
Cesar (28:00):
I don't know if you've seen the memes about the
insurance companies.
The insurance companies are outto basically reject and deny
anything you need them to pay.
Chris (28:10):
It's such a bullshit and I remember my coworker being
super worried.
He was like yo I don't know ifthey're going to reject this.
I don't know what's going tohappen.
Rob (28:19):
Don't they have AI chatbots that are designed to deny so
many percentage of claims orsomething like that?
Unitedhealthcare had that An AIthat was denying 90% of claims
and it was off and they knew it,but they let it run anyway.
Cesar (28:35):
Crazy times, anyway, healthcare Expensive, chris.
What'd you learn today, man?
Chris (28:39):
Like I never from the beginning, like I knew it was a
bullshit because of all the.
It's difficult and it's veryconfusing and it's I don't know,
it's a topic.
It's very uneasy too.
So it's like I have mixedfeelings about healthcare.
But sometimes I do feel bad forpeople that can't afford it or
(28:59):
don't have really nice ones, youknow, because I know what they
have to go through, because evenlike a little thing that
happens to me, that I always getpissed off and it takes a lot
of time just to resolve it and Ican't imagine what people have
to go through a daily basis.
To you know that people, eventhey, can't afford to do it.
Cesar (29:13):
So yeah, Victor, what about you, man?
Victor (29:16):
What about you, man?
I don't understand how we as acountry who love to talk about
our freedoms and our rights, andlove to talk about how
important our freedom of speechis, our freedom to bear arms,
but for somehow we missed thefreedom to be healthy, like as a
God given right, as if that'ssomething that should be for
(29:37):
profit or should be exploited.
That being said, I solved thehealthcare problem, so you know.
Rob (29:45):
Rob, it just seems that the way you explained it I mean
healthcare just is incrediblyconfusing.
It seems like there's so manyhands on the pot.
For it to have change, peoplehave to really care about it.
A lot of people have.
There's a lot of rich people,there's a lot of people who have
jobs that cover this type ofthing, and you're only really
(30:05):
going to hear about the peoplewho can afford it, and the young
don't even care.
So you know you have a smallamount of people who are really
getting hurt by these things.
And then the outliers, whereyou know the major cases where
you hear you know someone hascancer or something like that,
and then they're completelybankrupt these terrible stories.
But it's a confusing thing.
(30:25):
I don't even read my explanationof benefits.
I don't even look into thistype of stuff.
I go to the doctor.
They tell me it's 20 bucks.
I pay it.
I go the next week.
It's 25.
I'm like, okay, the prices wentup.
I don't even know how it works.
So I think majority of peopleprobably think that way too, and
if it's too confusing, they'reprobably really not looking into
it.
Either you got to set yourselfup or you got to be lucky enough
(30:48):
to have yourself set up to getthrough this, because you know
when you're young you don't eventhink about it.
As you get older, you knowyou're going to doctor a lot
more.
Chris (30:56):
There are people in this country where they're miserable
and they hate their job butbecause of the health care they
can't leave.
They're kind of like buying tothe job they're called public
sector workers.
Victor (31:11):
How crazy is that?
That we have something in ourConstitution that allows the
pursuit of happiness but we arestuck with jobs because of
health insurance.
That's the biggest.
One of the biggest limiters offreedom there is the fact that
it's tied to your job.
Cesar (31:27):
Oh yeah you're in prison at that point.
So there you have it A deepdive into why healthcare in the
US is so expensive.
From the insurance negotiationsto the inflated prices and the
lack of regulation, it's clearthat the system is complex, but
the stakes are incredibly high.
If you enjoyed today's show,hit that follow button and
spread the word of this amazingpodcast you've discovered.
(31:48):
We want you to be an activepart of our community, Whether
you have a question, suggestionor just want to share your
thoughts on our topics.
We want to hear from you.
Find us on Twitter at I'm NotDumb but, and on YouTube at I'm
not dumb but podcast.
Until next time, Remember, staycurious.
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