January 2, 2025 • 34 mins
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Speaker 1 (00:04):
It's that time time, time, time, Luck and Load.
Speaker 2 (00:11):
Michael Verie Show is on the air. Professor Charles Silver
is our guest.
Speaker 3 (00:25):
He's a professor at the University of Texas School of Law,
which I happen to believe is fantastic because I'm a
graduate of Saye, his book is Overcharged, Why Americans pay
too much for healthcare? You mentioned that the problem began
with Medicare Medicaid in the sixties, part of Lyndon Johnson's
(00:47):
Great Society, which turned out not to be. It was
two point zero of FDRs taking over of the American
economy and it's hard to strip that back out of
life when Medicare got involved. So my dad's eighty four,
my mom recently passed, and I go in and review
every expense, everything that comes in and all that this
(01:09):
whole Medicare thing. I have a show sponsor called Senior
Health Services dot Com, and he and his team help
people who are trying to navigate Medicare. And every day
I get someone who emails me and says, can you
connect me with them? And I forward it and sometimes
I stay involved for a little while just to see,
you know, kind of what they're working through. It's amazing
(01:32):
to people that, all of a sudden, I guess, when
you turn sixty five, you're getting robocalls and junk mail
and all this Medicare, Medicare, Medicare.
Speaker 4 (01:38):
And people had no idea.
Speaker 3 (01:40):
Now, all of a sudden, I've been, you know, dumped
into the Medicare playground, and I don't know why, how
does this even work?
Speaker 1 (01:52):
Too well?
Speaker 5 (01:53):
I just I recently hit that age myself, so I
can sympathize with those who's mail by are crammed with
Medicare advantage flyers and things of that sort. I'm sick
of seeing them. And I'm not even using Medicare. I'm
still working, so I'm staying on my employer's healthcare system
or healthcare insurance, although that is very expensive and far
(02:16):
too comprehensive. You know, it's because of the mandates regarding
what employer sponsored coverage has to conclude that I wind
up paying, you know, way too much. Everybody does pay
way too much for insurance. But you know, Medicare, what
can I say? It's a program that was designed to
(02:36):
succeed by massively inflating the deficit. You know, everybody thinks
that Medicare is something that you earn over the course
of your lifetime. We don't think of it as welfare,
and politicians who refer to it as welfare are excoriated.
But the amount that people pay into Medicare is way, way,
(02:56):
way smaller than the amount that they get out for
most people. Now they're obviously exceptions to that, but for
most people, the way that the program succeeds is by
charging them less than the benefits that they will get
out of the system.
Speaker 6 (03:13):
Well, you know, that's a nice arrangement.
Speaker 5 (03:14):
I'd like to have that, But the problem is somebody.
The money to pay for all those benefits has to
come from somewhere, and it.
Speaker 1 (03:22):
Only only two sources. One is general.
Speaker 5 (03:24):
Tax revenue, so they use money in addition tax revenue
in addition to the employee tax to fund the program.
And the other is deficit spending. And every one of
these expansions of the Medicare program is funded through the deficit.
So you know, back when Bush two was president, right
(03:46):
he created Medicare part D, the Prescription Drug Benefit Program. Well,
the premiums, even initially for that program were only set
at fifty percent of the estimated cost. Now they're down
to twenty five percent of the estimated cost, which means
everybody loves Medicare party because it's a great deal. Right,
I'm only paying twenty five percent of the cost. But
(04:08):
what you're really doing is taking the cost of prescription
drugs and rolling them into the deficit. And the same
thing goes for Obamacare with all these premium subsidies. Everything
that the government does is designed to be popular by
being priced below.
Speaker 1 (04:25):
Its actual cost, and the.
Speaker 5 (04:28):
Result of that in the long run has to be
deficit increases and inflation increases.
Speaker 1 (04:35):
There's just no getting around that.
Speaker 3 (04:37):
It's frustrating because then Medicare, the government is telling you
which doctors you can go to and which you can't,
which procedures you can do in which you can't, and
so you know, and look, it sounds like you and
I are relatively aligned. I was an acolyte of Professor
Leino Graia, so you can probably understand where my views
are with regard to politics and the role of the
(05:00):
government and the individual. I'm probably more libertarian certainly than
he was. I'm over on the Rand and Ron Paul
end of things. But what I find frustrating is that
people seem to think that somehow government is protecting you
and aiding you. But in fact, what goes with that is,
(05:22):
you know why you don't feed the bears at the zoo,
is they're controlling you, and any government powerful enough to
pay for your medical surgery or medical procedures, powerful enough
to take it away, and then they start making decisions
for you. And that's where we get into the civil liberties.
And that's where I get very frustrated, because we've now
moved beyond healthcare and we've moved into a sort of
(05:44):
totalitarian authoritarian control of the individual.
Speaker 5 (05:49):
Well, you're certainly singing my song because you know you're
a libertarian. I'm an adjunct scholar at the Cato Institute.
Speaker 1 (05:56):
I don't think it gets much.
Speaker 5 (05:57):
More libertarian than that, I would say, so, so we're
on the same page as far as, you know, being
very very concerned about the governmental control. I think that
governmental control is part of the story, but I think
governmental ineptitude is probably a much bigger part of the story.
(06:23):
You know, I'm willing to say, oh, some of those
you know, bureaucrats who run these programs actually want to
want to help people, and may even believe they are
helping people. But it's actually very difficult to run the
healthcare system. Well, that's why market forces are so important,
because market forces are constantly rewarding providers for figuring out
(06:48):
how to serve patients better.
Speaker 1 (06:50):
Right, that's how you can get business. If you can.
Speaker 5 (06:52):
Figure out how to serve your customers better, then you'll
get more customers. And that's just something that requires wires
people who know that nuts and bolts really well, to
be constantly reflecting on how they're doing their jobs.
Speaker 1 (07:07):
Right.
Speaker 5 (07:08):
The government bureaucrats, they don't do that. They don't even
know how the jobs work. They just exist mainly to
pay bills and to enact regulations that enable them to
deal with the burden that all this imposes on the
federal government. And the results for consumers are just terrible.
You know, all these problems that everybody complains about, prior
(07:31):
authorization requirements, surprise bills, these things called facility fees that you.
Speaker 1 (07:37):
Know, you go to an emergency room.
Speaker 5 (07:39):
The doctor says, oh, you've got a fever, take some
aster and go home, and then you get a build
for ten thousand dollars because you literally because you.
Speaker 1 (07:46):
Walked in the front doors.
Speaker 5 (07:47):
It's just like a cover charge at a bar or
something like that, except a lot bigger. You know, none
of that stuff exists in the direct payment system. It
all exists because the government regulates the way healthcare is.
Speaker 1 (08:04):
Delivered, and it does it in stupid.
Speaker 5 (08:06):
Ways because it's hard to do it right.
Speaker 3 (08:10):
And government's not in the business of efficiency. Professor Charles
Silver is our guest. The book is Overcharged, Why you
Americans pay too much for healthcare?
Speaker 1 (08:22):
And the Michael Berry Show good not.
Speaker 3 (08:29):
Professor Charles Silver of the University of Texas School of
Law is our guest. He was I have come to
learn in the course of our conversation at ut Law
almost ten years before I was there, and still is.
I did not know him, but I happened to think
the world of that law school, and I gained a
(08:49):
lot from being there, both associations and education. And this
book has been highly recommended to me by numerous folks
as to how to gain a better understanding of why
the healthcare system costs you so much. Overcharged, Why Americans
pay too much for healthcare? Professor Charles Silver is our guest. Professor,
(09:12):
let's talk about young people. By young I'm fifty three,
so I'm gonna throw myself into there. You know, I've
read that something like half the healthcare costs in this
country are expended on people within the last two years
of their lives. And you know, we see this where
it's just constant. It's just one thing after another after another,
and then they pass and then you kick in the
(09:34):
funeral industry, and I mean it's these are all industries,
like the bridal industry and the birthing industry. When you
look at a person who is relatively healthy without a
chronic condition, and you're looking at the cost to them
that they're bearing, which really is the risk you're willing
(09:55):
to assume. Right, if you're never going to need a doctor,
then you don't need insurance. We just don't know which
one of us is going to be in a car
wreck or have a heart attack. So we're trying the
same way we leverage the risk on if our house
burns down. We're trying to kind of to keep that
at bay and to make a good financial decision. Where
(10:15):
is that going wrong today? Because my guess is most
people are overpaying for insurance coverage that they won't need
until much later. That's going toward people at their end
of life. Oh, I agree that I think that story
is right. There are a bunch of thoughts that it prompts.
Speaker 5 (10:34):
One of them is, you know, I've never been a
fan of taxing people who are relatively young to provide
benefits to people who are relatively old. That strikes me
is wrong on a variety of levels.
Speaker 1 (10:47):
You know.
Speaker 5 (10:47):
One is, every moral theory that I know of says
you move money from richer people to poorer people. Well,
older people are wealthier than younger people. Be surprising to anybody.
They've had their whole lives to work right and save.
They've paid off their cars, they've paid off their homes.
You know, they have other assets. Right, They're on average,
(11:09):
much wealthier than younger people who are struggling, you know,
raising families, you know, just getting jobs.
Speaker 1 (11:15):
Dealing with college debt and all that stuff.
Speaker 5 (11:18):
So my moral view is if we were going to
move money in any direction, we should move it from
older people to younger people. But our system does the reverse.
We're robbing the poor to pay the rich. I don't
understand that. Another thing is, excuse me, the system really
(11:40):
disserves people because it eliminates all caps on spending.
Speaker 1 (11:46):
You were talking about.
Speaker 5 (11:47):
End of life care and how we spend so much
money in the last year or two of people's lives.
Speaker 1 (11:52):
Well, if people had.
Speaker 5 (11:54):
To spend their own money, nobody would spend an infinite
amount in their last two years healthcare. They would have
to make hard decisions, right, These are not pleasant decisions,
but they would make decisions about how much healthcare they want.
Is it worth spending a million dollars to extend my
life by a month, Right, that's the kind of decision
(12:14):
they would have to make. Well, today, because we've removed
all caps from the system, nobody has to make those decisions. Instead,
we just spend literally an infinite amount of money on
people who are in the final stages of their illness.
Speaker 1 (12:30):
We get no bang for the buck. You know, we have.
Speaker 5 (12:33):
People, literally we have people who are receiving cancer treatments,
new cancer treatments that cost a million dollars, and all
those treatments do is extend their lives by about a month.
And it's not even a good month. It's not a
month when you're going to be out there on the
golf course, playing with your buddies and drinking beer. It's
a month like you're in the hospital right for the
(12:55):
whole month.
Speaker 6 (12:56):
These things just make no sense.
Speaker 5 (12:58):
Right, But the government cannot make those decisions, literally, it
cannot because the moment the government starts talking about rationing care,
everybody loses their minds and you don't want to be
the politician that they're rallying against. Right, So the government
simply ignores the need to make these decisions and just
(13:22):
spends endless amounts of money because it's other people's money.
So why does the government care?
Speaker 6 (13:27):
Right? And you know, we just have to.
Speaker 5 (13:32):
Come back to the world in which people are responsible
for their own end of life care. You know, it's
a sad thing, but it's true. We will all die
at some point, and the fact that we will all
die at some point affects a thousand.
Speaker 6 (13:50):
Decisions that each of us makes.
Speaker 5 (13:52):
Right, When am I going to stop working? Well, if
I'm thinking I don't have much longer to live, it
probably will stop working so I can stand my last
you know, a couple of years with my family or
traveling or whatever it is, right, I mean, if you
start to think about it, knowing that at some point
we will all die, it affects, as I said, thousands
(14:13):
of decisions that we make you know, do I want
to live in this house that I'm in now until
the end of my life, or do I want to
move to a house that's more handicap equipped and things
of that sort. Right, this is just another decision. It's
a tough decision. I'm not trying to say otherwise, but
it's a decision that needs.
Speaker 1 (14:31):
To be made, and it needs to be made not.
Speaker 5 (14:33):
By the government, but by the people who are directly
involved and who can think hard about all these tough problems.
There's no way the government's going to make a good decision.
Their incentives are wrong, their knowledge is too limited, they
don't have access to the counselors that individuals will talk
to and making these.
Speaker 1 (14:51):
Kinds of decisions.
Speaker 6 (14:53):
So, you know, we just have.
Speaker 5 (14:54):
To get the government out of this business. What I
have proposed is.
Speaker 1 (15:01):
That we can.
Speaker 5 (15:01):
You know, there is one other problem though that we
haven't discussed, which we do need to discuss, which is
there are some people who are too poor to afford
fundamental health care. We do need to come up with
a way of dealing with those people, because when they
show up at the hospital needing healthcare, they're not going
to be turned away. Right now, We're not going to
be having sick people dying in the streets because they
(15:23):
can't afford healthcare. So we need to come up with
a way to deal with that. But the obvious way
to deal with that is through a negative income text,
the sort of thing that Milton Friedman proposed. You know,
you provide everybody with a kind of amount of sustenance
that they can use for this purpose. You could put
it into a restricted medical account if you wanted, But
(15:45):
the idea is once you give it to them, it's
hands off for the rest of it. The government doesn't
get involved in the delivery of healthcare.
Speaker 1 (15:52):
It just people make.
Speaker 5 (15:53):
Decisions on themselves with their own money, and life goes forward.
And I think if we did that, the healthcare system
would operate much more efficiently.
Speaker 3 (16:03):
Well, the great frustration, as you know, is that everybody
gets a vote, even people that make bad decisions, and
that many people make bad decisions. You know that we
will have a lot of people who say I can't
afford medical care because they don't save money. But they've
got a big screen TV in every room, and they've got,
you know, a car they can't afford that they're driving.
Speaker 4 (16:26):
They end up with the car that they can't afford,
and we end up paying.
Speaker 3 (16:28):
For the healthcare that they can't afford to The book
is Overcharged, Why Americans Pay Too Much for Healthcare?
Speaker 4 (16:35):
Professor Charles Silver, And.
Speaker 1 (16:37):
Everybody knows who this guy is.
Speaker 3 (16:38):
Come on, man with the Michael Barrier, Come on, Professor
Charles Silver is our guest. It's a subject of great
interest to me and too many of you.
Speaker 4 (16:50):
The book is.
Speaker 3 (16:50):
Called Overcharged, Why Americans Pay Too Much for Healthcare? He
is a law professor at the University of Texas at
Austin School of Law. And we ended the last segment
with the discussion that at the end of the day,
the allocation of scarce resources and who will make that decision.
(17:12):
We're back at that point again in every family. You know,
you got eight kids and you've got one chicken. Mom
says you're not getting a second piece. So there's some
cartilage left on that leg. If you're hungry, you'll eat that.
And there comes a point where we have to decide
(17:33):
with scarce resources, who will make the decision as to
where those resources will be deployed.
Speaker 4 (17:39):
Will it be the government or will it be the individual?
Speaker 3 (17:42):
And if it's the individual, there will be those who say, well,
I want as much as my neighbor has, Okay, we'll
earn the money to purchase that. Well, I don't earn
as much. I want to use the power of the
gun through at the direction of the government that I
either more of me than there of the rich people
I vote for. I want that well. The only alternative
(18:04):
is for the government to do it. Professor I harkened
back to a study, and it's been a while since
I read this book. It's interesting because I'm a believer
and let the marketplace decide. You know, healthcare is the
one area where we think everybody gets all the healthcare
they want, but we all end up paying for that.
We don't say everybody gets all the food they want,
(18:25):
or all the cars they want, or all the houses
they want, or all the clothes they want, but for
some reason, everybody gets all the healthcare they want, even
at the point that it's throwing good money after bad.
So socialist system the opposite of what I propose. In Sweden,
they did a study, and it was a multi decade
study you may be aware of it, on prostate cancer
in men, and they determined that out of I think
(18:50):
it was three thousand men who had prostate cancer who
were diagnosed with prostate cancer, and they chose not to
treat the prostate cancer. And they did about a twenty
five year study and the number of men who died
of untreated prostate cancer was something like thirty out of
three thousand. So they came to the conclusion with a government,
(19:14):
completely government run system, that with scarce resources, it does
not make sense for us to treat prostate cancer per
se because nobody, very few people are going to die
of prostate cancer. Let's spend our money on other things
that if we don't spend it there, you die.
Speaker 4 (19:32):
And it strikes me.
Speaker 3 (19:33):
That while that's the opposite of the capitalist system, there
does need to be an understanding that we're wasting a
lot of money on studies because and this gets to
the second point of what you've written a lot about
medical malpractice and the fear of medical malpractice.
Speaker 4 (19:51):
I don't think everybody.
Speaker 3 (19:52):
Needs a glaucoma test every time they go for their license,
but god forbid one person not be diagnosed with glaucoma.
We're practicing defensive medicine. We're over ordering tests, which is
a waste of our time and energy, but also money,
and we're not actually doing we're not engaged in what
(20:12):
I would consider smart effective healing because everyone is afraid
of being sued.
Speaker 4 (20:18):
And that has we get back to our point.
Speaker 3 (20:21):
The book is overcharged, Why Americans pay too much for healthcare?
I think that's a big portion of what we spend.
Your thought, well.
Speaker 5 (20:29):
I'm going to disagree with part of that, but I
agree with a lot of it as well. In my world,
when you have a self interested explanation or something, you
probably don't have to look very far for any other explanation.
Self interest usually is a pretty good explanation. And the reason,
you know, some people say, oh, the reason that doctors
(20:52):
overtreat is because they're afraid of being sued. Well, there's
a simpler self interested explanation, which is every time they
treat somebody, they make money, and until you take the
profit out of these services, which will never happen, it's
very hard to determine that they're actually engaging in any
(21:13):
real defensive medicine at all. There are lots of studies
that are out there now that have found.
Speaker 1 (21:19):
That, I mean, defensive medicine is kind.
Speaker 5 (21:22):
Of hard to define because it can be both it
can be both the provision of services that aren't needed
and the avoidance of services that are needed, because you
get sued when you do deliver services as well as
when you withhold them. So it's hard to figure out
exactly what's going on with defensive medicine. But as I said,
(21:44):
I don't think we really need to worry about it
very much because we have a self interested explanation, which
is that the services are profitable. And there's also you know,
doctors have a lot of confidence in their ability to
help people, and they have a very strong desire to
help people.
Speaker 1 (21:59):
Right, that's what it should be.
Speaker 5 (22:01):
You know.
Speaker 3 (22:01):
You remind me of another great document written in seventeen
seventy six, and that from a Scotsman named Adam Smith,
who famously said, it is not from the benevolence of
the butcher, or the brewer or the baker that we
expect our dinner, but from their regard to their own
self interest. And exactly self interest drives so many things.
(22:25):
That guy is not standing on his feet behind the
counter at the donut shop for so many hours and
didn't get there at two thirty this morning because he's
a nice guy.
Speaker 4 (22:34):
He wants to make a profit off the donuts.
Speaker 3 (22:36):
I get to enjoy the donuts in exchange for the
currency that I was given for the sweat of my brow.
Speaker 4 (22:42):
It works, and I think we have to return that
to the process. And I think that's where you and
I can agree.
Speaker 5 (22:49):
I think we do agree on that, but we also
agree that I mean, these social programs have fundamentally undermined
the incentive to save and to be self reliant.
Speaker 1 (23:04):
You know, the I think, you know, I constantly.
Speaker 5 (23:08):
Read articles about how many people are retiring and all
they have to live on is social security and medicare
They don't have much in the way of savings. And
people say, well, how could you possibly you know, let
that happen?
Speaker 6 (23:22):
Right?
Speaker 5 (23:22):
Why are you buying, as you put it, those you know,
big screen TVs for every room when you should be
saving for your later years. I think the answer is
that most people naively think, oh, the government's just going
to take care of me in my later years, so
I don't have to save, and they, you know, the
temptation to spend money now rather than later, it's always there.
(23:43):
Who wants to save? Saving is boring?
Speaker 1 (23:45):
Right?
Speaker 5 (23:47):
Consuming today is fun? So, you know, I think that
as long as we have these paygo programs where you
know you can keep getting money out above what you
put in, that the incentives to save will forever be undermined.
And that's a terrible thing, I think, because, as you said,
(24:08):
you know, we're just getting ourselves into this world where
each of us expects everybody else to pay for everything
that we need. If it's only healthcare, they still expect
to pay for everything that they want, and that just
drives costs through the roof without really any offsetting benefits
that make sense of it.
Speaker 3 (24:27):
Zoologists will tell you you are doing great harm by
domesticating certain breeds of animals, particularly if you intend at
some point to release them into the wild.
Speaker 4 (24:39):
You make them slaves.
Speaker 3 (24:40):
They lose the very abilities, and we've seen with evolutionary
studies that teeth are not as sharpenning longer, claws are
not as sharpenning more, they can no longer run as fast.
They grow to be like prison inmates, dependent on someone
else to provide for them, and I think that has
to be understood by people. Our guest is Professor Charles Silver,
(25:04):
who will be with us for one more segment. The
book is overcharged. Why Americans pay too much.
Speaker 1 (25:12):
That's it. Arrest me or take me to Texas. So
many gets out of this state.
Speaker 6 (25:17):
I think Michael Berry Robins show I like you.
Speaker 3 (25:23):
Professor Charles Silver of the University of Texas School of Law,
my alma mater, has graciously spent quite a bit of
time with us discussing an area of his academic expertise
and prowess. The book is Overcharged, Why Americans pay too
much for healthcare? And folks, I have to say, as
you've heard me say many times, politics is interesting, you know,
(25:48):
the rooting for your team versus that team, the Trump Dance,
the reds and Blues, and who shows up and only.
But my primary interest at the end of the day
is not my team winning and your team losing. The
primary interest is creating a structure where the individual can thrive,
where there is opportunity and fairness, safeguard's rule of law,
(26:11):
and that will, at the end of the day, advance humanity.
It always has. It's the only thing that does not government.
And so these sort of policy discussions, I understand are
probably less thrilling than my usual screaming and hollering about
this or that indignity of the day. But this is
what matters. This is why we get involved in campaigns,
(26:34):
is to take control of the government and get it
out of our lives and create safeguards and reduce regulation
and promote the rule of law so that hardworking people
can create enough John Gault style for the rest of
us to prosper. And this stuff matters. So that's why
we have these conversations. Professor Charlesolver, overcharged, why Americans pay
(26:56):
too much for healthcare?
Speaker 4 (26:57):
Professor Silver, I want you to be king for a day.
You have no.
Speaker 3 (27:03):
As this benevolent monarch, you have no political concerns. Reconstruct
our health care facility to provide an opportunity for the
most healing to occur and the individuals to take control
of their own healthcare.
Speaker 4 (27:18):
What does that look like?
Speaker 5 (27:22):
Wow, I'm nervous about being king for a day because
I don't believe in kings, I know, but I'll try.
I think we basically wipe away everything in terms of
these programs and the restrictive regulations. You know, have you
ever heard of a certificate of need law?
Speaker 1 (27:43):
I don't know. They're called con laws by for short,
but con.
Speaker 5 (27:47):
Laws regulate how many new healthcare providers can set up shops.
So if you want to open a hospital, you got
to get permission. Oh okay, I guess what the way
the common laws work. The existing hospitals have a vote
and whether you can open a new hospital, or like
giving McDonald's a vote on whether Burger King can open
(28:11):
a restaurant right across the street.
Speaker 1 (28:14):
It just doesn't make any sense.
Speaker 5 (28:15):
But that's the way I would get rid of all
of those supply constraining regulations, and I would get rid
of all of these programs Obamacare, Medicare, whatever, and I
would go to a very simple wealth distribution program. I'm
not sure exactly how much money it should be. That's
(28:36):
something that has to have some work done. But you
know we're currently spending if you put all the healthcare
programs together, you know, we're spending like seven eight ten
thousand dollars a person per you know, per American through
these programs. If we just took some of that money
and started plunking it into restricted healthcare savings accounts for
(28:59):
people year, you know, there's just a little bit more
that's put in. Pretty soon everybody would have enough money
to pay for their basic needs and to buy catastrophic insurance,
and I would let people buy just as much catastrophic
insurance as they want.
Speaker 1 (29:14):
I wouldn't have coverage mandates.
Speaker 5 (29:16):
You know, right now, if you want to buy a
policy on one of the exchanges and you're a young man,
you know you have to pay for annual mammograms, right,
but you're not getting mammograms because you're a man, right right,
So you know, I wouldn't force people to buy any
(29:37):
particular amount of coverage. And I would let insurance companies
limit the total payouts, which you know, that's.
Speaker 1 (29:44):
Really where things are screwed up right now.
Speaker 5 (29:47):
It's one of the areas, right they have to spend
unlimited amounts of money on people. I would let people
let design their own insurance programs, and I think that
you know, it's not going to work perfectly. Nothing ever
works perfectly, right, But it would work so much better
and be so much more efficient than the existing system,
and it'd be way more consumer friendly. And that's a
(30:10):
huge improvement because I don't know anybody who is happy
with the existing healthcare system. I mean, this terrible murder
that just occurred has brought to the surface the extraordinary
hatred that people have toward insurance companies. You know, that's
just one symptom. We're spending twice as much as any
(30:34):
other country on healthcare, and we're getting less and less
healthy every year. You know, our life expectancy is declining.
We're just doing everything wrong that we possibly can do.
So wipe the slate, get rid of all this stuff.
Start out with a really simple direct payment system and
a cash transfer system to deal with people who are
(30:55):
so poor that they can't even afford the basics, and
just be satisfied with that. I said, it's not gonna
be perfect, but it'd be hard to improve on all, right.
Speaker 3 (31:06):
Yeah, And to get outside the purview of what we've discussed,
but to speak more to the process that lands us
where we are.
Speaker 4 (31:15):
Our criminal justice system.
Speaker 3 (31:16):
We spend more on imprisoning and prosecuting and chasing down
bad guys in any other country in the world.
Speaker 4 (31:24):
And yes, I think we do.
Speaker 3 (31:25):
A far worse job, at less effective job than most
countries in the world.
Speaker 4 (31:30):
And I think much of that you can see.
Speaker 3 (31:33):
Some similarities and patterns that pervade those two industries. And
by the way, then we could move over into public
education and education generally.
Speaker 1 (31:44):
There are a.
Speaker 3 (31:45):
Number of different applications for where this process has gone wrong,
and it is frustrating. I very much appreciate your time, professor,
feel the better for it. The book is overcharged Why
Americans pay too much for healthcare? Professor Charles Silver of
(32:08):
the University of Texas.
Speaker 1 (32:09):
School of Law. Thank you, sir, Thank you, Michael pleasure.
Speaker 3 (32:13):
And with that, might I suggest to each and every
one of you that while politics is an interesting undertaking,
and it is you know, winning elections, and he said this,
and we're going to show him, and.
Speaker 4 (32:27):
You know, it's a battle royale, and you.
Speaker 3 (32:29):
Know I argued with my cousin at the Thanksgiving table,
at the end of it all, the reason for the arguments,
reason for the elections should be very redemptive, very practical,
not just existential, not just ideological. They're real to your life,
(32:54):
and that is creating a governmental system where individuals are
free to thrive. Government is not just. Government is not merciful.
Government is not protective, It is not good. Government is clunky,
(33:15):
it's inefficient. If you've stood in line of the DPS
office to get your driver's license and thought to yourself,
you could move this thing along. If you've seen someone
who is on the clock and doesn't care about results.
If you've seen the worst of government in every aspect,
whether it's the inspector who doesn't seem to care, that
(33:36):
they're coming back and adding these regulations that are going
to cost this much more for you to build this,
and now you're going to walk away from the project
and lead the property vacant, and that's not good for anybody.
Speaker 1 (33:47):
These are the.
Speaker 4 (33:48):
Things that we should spend our time with.
Speaker 3 (33:51):
And I say this because politics has become sport and
it's become for many.
Speaker 4 (33:56):
People their favorite hobby.
Speaker 3 (33:58):
But let's not lose track of what we're trying trying
to do here, which is literal, not to exaggerate, to
save our country.
Speaker 4 (34:04):
Exelman Els has left the building.
Speaker 1 (34:07):
Thank you, and good night.
It's that time time, time, time, Luck and Load.
Speaker 2 (00:11):
Michael Verie Show is on the air. Professor Charles Silver
is our guest.
Speaker 3 (00:25):
He's a professor at the University of Texas School of Law,
which I happen to believe is fantastic because I'm a
graduate of Saye, his book is Overcharged, Why Americans pay
too much for healthcare? You mentioned that the problem began
with Medicare Medicaid in the sixties, part of Lyndon Johnson's
(00:47):
Great Society, which turned out not to be. It was
two point zero of FDRs taking over of the American
economy and it's hard to strip that back out of
life when Medicare got involved. So my dad's eighty four,
my mom recently passed, and I go in and review
every expense, everything that comes in and all that this
(01:09):
whole Medicare thing. I have a show sponsor called Senior
Health Services dot Com, and he and his team help
people who are trying to navigate Medicare. And every day
I get someone who emails me and says, can you
connect me with them? And I forward it and sometimes
I stay involved for a little while just to see,
you know, kind of what they're working through. It's amazing
(01:32):
to people that, all of a sudden, I guess, when
you turn sixty five, you're getting robocalls and junk mail
and all this Medicare, Medicare, Medicare.
Speaker 4 (01:38):
And people had no idea.
Speaker 3 (01:40):
Now, all of a sudden, I've been, you know, dumped
into the Medicare playground, and I don't know why, how
does this even work?
Speaker 1 (01:52):
Too well?
Speaker 5 (01:53):
I just I recently hit that age myself, so I
can sympathize with those who's mail by are crammed with
Medicare advantage flyers and things of that sort. I'm sick
of seeing them. And I'm not even using Medicare. I'm
still working, so I'm staying on my employer's healthcare system
or healthcare insurance, although that is very expensive and far
(02:16):
too comprehensive. You know, it's because of the mandates regarding
what employer sponsored coverage has to conclude that I wind
up paying, you know, way too much. Everybody does pay
way too much for insurance. But you know, Medicare, what
can I say? It's a program that was designed to
(02:36):
succeed by massively inflating the deficit. You know, everybody thinks
that Medicare is something that you earn over the course
of your lifetime. We don't think of it as welfare,
and politicians who refer to it as welfare are excoriated.
But the amount that people pay into Medicare is way, way,
(02:56):
way smaller than the amount that they get out for
most people. Now they're obviously exceptions to that, but for
most people, the way that the program succeeds is by
charging them less than the benefits that they will get
out of the system.
Speaker 6 (03:13):
Well, you know, that's a nice arrangement.
Speaker 5 (03:14):
I'd like to have that, But the problem is somebody.
The money to pay for all those benefits has to
come from somewhere, and it.
Speaker 1 (03:22):
Only only two sources. One is general.
Speaker 5 (03:24):
Tax revenue, so they use money in addition tax revenue
in addition to the employee tax to fund the program.
And the other is deficit spending. And every one of
these expansions of the Medicare program is funded through the deficit.
So you know, back when Bush two was president, right
(03:46):
he created Medicare part D, the Prescription Drug Benefit Program. Well,
the premiums, even initially for that program were only set
at fifty percent of the estimated cost. Now they're down
to twenty five percent of the estimated cost, which means
everybody loves Medicare party because it's a great deal. Right,
I'm only paying twenty five percent of the cost. But
(04:08):
what you're really doing is taking the cost of prescription
drugs and rolling them into the deficit. And the same
thing goes for Obamacare with all these premium subsidies. Everything
that the government does is designed to be popular by
being priced below.
Speaker 1 (04:25):
Its actual cost, and the.
Speaker 5 (04:28):
Result of that in the long run has to be
deficit increases and inflation increases.
Speaker 1 (04:35):
There's just no getting around that.
Speaker 3 (04:37):
It's frustrating because then Medicare, the government is telling you
which doctors you can go to and which you can't,
which procedures you can do in which you can't, and
so you know, and look, it sounds like you and
I are relatively aligned. I was an acolyte of Professor
Leino Graia, so you can probably understand where my views
are with regard to politics and the role of the
(05:00):
government and the individual. I'm probably more libertarian certainly than
he was. I'm over on the Rand and Ron Paul
end of things. But what I find frustrating is that
people seem to think that somehow government is protecting you
and aiding you. But in fact, what goes with that is,
(05:22):
you know why you don't feed the bears at the zoo,
is they're controlling you, and any government powerful enough to
pay for your medical surgery or medical procedures, powerful enough
to take it away, and then they start making decisions
for you. And that's where we get into the civil liberties.
And that's where I get very frustrated, because we've now
moved beyond healthcare and we've moved into a sort of
(05:44):
totalitarian authoritarian control of the individual.
Speaker 5 (05:49):
Well, you're certainly singing my song because you know you're
a libertarian. I'm an adjunct scholar at the Cato Institute.
Speaker 1 (05:56):
I don't think it gets much.
Speaker 5 (05:57):
More libertarian than that, I would say, so, so we're
on the same page as far as, you know, being
very very concerned about the governmental control. I think that
governmental control is part of the story, but I think
governmental ineptitude is probably a much bigger part of the story.
(06:23):
You know, I'm willing to say, oh, some of those
you know, bureaucrats who run these programs actually want to
want to help people, and may even believe they are
helping people. But it's actually very difficult to run the
healthcare system. Well, that's why market forces are so important,
because market forces are constantly rewarding providers for figuring out
(06:48):
how to serve patients better.
Speaker 1 (06:50):
Right, that's how you can get business. If you can.
Speaker 5 (06:52):
Figure out how to serve your customers better, then you'll
get more customers. And that's just something that requires wires
people who know that nuts and bolts really well, to
be constantly reflecting on how they're doing their jobs.
Speaker 1 (07:07):
Right.
Speaker 5 (07:08):
The government bureaucrats, they don't do that. They don't even
know how the jobs work. They just exist mainly to
pay bills and to enact regulations that enable them to
deal with the burden that all this imposes on the
federal government. And the results for consumers are just terrible.
You know, all these problems that everybody complains about, prior
(07:31):
authorization requirements, surprise bills, these things called facility fees that you.
Speaker 1 (07:37):
Know, you go to an emergency room.
Speaker 5 (07:39):
The doctor says, oh, you've got a fever, take some
aster and go home, and then you get a build
for ten thousand dollars because you literally because you.
Speaker 1 (07:46):
Walked in the front doors.
Speaker 5 (07:47):
It's just like a cover charge at a bar or
something like that, except a lot bigger. You know, none
of that stuff exists in the direct payment system. It
all exists because the government regulates the way healthcare is.
Speaker 1 (08:04):
Delivered, and it does it in stupid.
Speaker 5 (08:06):
Ways because it's hard to do it right.
Speaker 3 (08:10):
And government's not in the business of efficiency. Professor Charles
Silver is our guest. The book is Overcharged, Why you
Americans pay too much for healthcare?
Speaker 1 (08:22):
And the Michael Berry Show good not.
Speaker 3 (08:29):
Professor Charles Silver of the University of Texas School of
Law is our guest. He was I have come to
learn in the course of our conversation at ut Law
almost ten years before I was there, and still is.
I did not know him, but I happened to think
the world of that law school, and I gained a
(08:49):
lot from being there, both associations and education. And this
book has been highly recommended to me by numerous folks
as to how to gain a better understanding of why
the healthcare system costs you so much. Overcharged, Why Americans
pay too much for healthcare? Professor Charles Silver is our guest. Professor,
(09:12):
let's talk about young people. By young I'm fifty three,
so I'm gonna throw myself into there. You know, I've
read that something like half the healthcare costs in this
country are expended on people within the last two years
of their lives. And you know, we see this where
it's just constant. It's just one thing after another after another,
and then they pass and then you kick in the
(09:34):
funeral industry, and I mean it's these are all industries,
like the bridal industry and the birthing industry. When you
look at a person who is relatively healthy without a
chronic condition, and you're looking at the cost to them
that they're bearing, which really is the risk you're willing
(09:55):
to assume. Right, if you're never going to need a doctor,
then you don't need insurance. We just don't know which
one of us is going to be in a car
wreck or have a heart attack. So we're trying the
same way we leverage the risk on if our house
burns down. We're trying to kind of to keep that
at bay and to make a good financial decision. Where
(10:15):
is that going wrong today? Because my guess is most
people are overpaying for insurance coverage that they won't need
until much later. That's going toward people at their end
of life. Oh, I agree that I think that story
is right. There are a bunch of thoughts that it prompts.
Speaker 5 (10:34):
One of them is, you know, I've never been a
fan of taxing people who are relatively young to provide
benefits to people who are relatively old. That strikes me
is wrong on a variety of levels.
Speaker 1 (10:47):
You know.
Speaker 5 (10:47):
One is, every moral theory that I know of says
you move money from richer people to poorer people. Well,
older people are wealthier than younger people. Be surprising to anybody.
They've had their whole lives to work right and save.
They've paid off their cars, they've paid off their homes.
You know, they have other assets. Right, They're on average,
(11:09):
much wealthier than younger people who are struggling, you know,
raising families, you know, just getting jobs.
Speaker 1 (11:15):
Dealing with college debt and all that stuff.
Speaker 5 (11:18):
So my moral view is if we were going to
move money in any direction, we should move it from
older people to younger people. But our system does the reverse.
We're robbing the poor to pay the rich. I don't
understand that. Another thing is, excuse me, the system really
(11:40):
disserves people because it eliminates all caps on spending.
Speaker 1 (11:46):
You were talking about.
Speaker 5 (11:47):
End of life care and how we spend so much
money in the last year or two of people's lives.
Speaker 1 (11:52):
Well, if people had.
Speaker 5 (11:54):
To spend their own money, nobody would spend an infinite
amount in their last two years healthcare. They would have
to make hard decisions, right, These are not pleasant decisions,
but they would make decisions about how much healthcare they want.
Is it worth spending a million dollars to extend my
life by a month, Right, that's the kind of decision
(12:14):
they would have to make. Well, today, because we've removed
all caps from the system, nobody has to make those decisions. Instead,
we just spend literally an infinite amount of money on
people who are in the final stages of their illness.
Speaker 1 (12:30):
We get no bang for the buck. You know, we have.
Speaker 5 (12:33):
People, literally we have people who are receiving cancer treatments,
new cancer treatments that cost a million dollars, and all
those treatments do is extend their lives by about a month.
And it's not even a good month. It's not a
month when you're going to be out there on the
golf course, playing with your buddies and drinking beer. It's
a month like you're in the hospital right for the
(12:55):
whole month.
Speaker 6 (12:56):
These things just make no sense.
Speaker 5 (12:58):
Right, But the government cannot make those decisions, literally, it
cannot because the moment the government starts talking about rationing care,
everybody loses their minds and you don't want to be
the politician that they're rallying against. Right, So the government
simply ignores the need to make these decisions and just
(13:22):
spends endless amounts of money because it's other people's money.
So why does the government care?
Speaker 6 (13:27):
Right? And you know, we just have to.
Speaker 5 (13:32):
Come back to the world in which people are responsible
for their own end of life care. You know, it's
a sad thing, but it's true. We will all die
at some point, and the fact that we will all
die at some point affects a thousand.
Speaker 6 (13:50):
Decisions that each of us makes.
Speaker 5 (13:52):
Right, When am I going to stop working? Well, if
I'm thinking I don't have much longer to live, it
probably will stop working so I can stand my last
you know, a couple of years with my family or
traveling or whatever it is, right, I mean, if you
start to think about it, knowing that at some point
we will all die, it affects, as I said, thousands
(14:13):
of decisions that we make you know, do I want
to live in this house that I'm in now until
the end of my life, or do I want to
move to a house that's more handicap equipped and things
of that sort. Right, this is just another decision. It's
a tough decision. I'm not trying to say otherwise, but
it's a decision that needs.
Speaker 1 (14:31):
To be made, and it needs to be made not.
Speaker 5 (14:33):
By the government, but by the people who are directly
involved and who can think hard about all these tough problems.
There's no way the government's going to make a good decision.
Their incentives are wrong, their knowledge is too limited, they
don't have access to the counselors that individuals will talk
to and making these.
Speaker 1 (14:51):
Kinds of decisions.
Speaker 6 (14:53):
So, you know, we just have.
Speaker 5 (14:54):
To get the government out of this business. What I
have proposed is.
Speaker 1 (15:01):
That we can.
Speaker 5 (15:01):
You know, there is one other problem though that we
haven't discussed, which we do need to discuss, which is
there are some people who are too poor to afford
fundamental health care. We do need to come up with
a way of dealing with those people, because when they
show up at the hospital needing healthcare, they're not going
to be turned away. Right now, We're not going to
be having sick people dying in the streets because they
(15:23):
can't afford healthcare. So we need to come up with
a way to deal with that. But the obvious way
to deal with that is through a negative income text,
the sort of thing that Milton Friedman proposed. You know,
you provide everybody with a kind of amount of sustenance
that they can use for this purpose. You could put
it into a restricted medical account if you wanted, But
(15:45):
the idea is once you give it to them, it's
hands off for the rest of it. The government doesn't
get involved in the delivery of healthcare.
Speaker 1 (15:52):
It just people make.
Speaker 5 (15:53):
Decisions on themselves with their own money, and life goes forward.
And I think if we did that, the healthcare system
would operate much more efficiently.
Speaker 3 (16:03):
Well, the great frustration, as you know, is that everybody
gets a vote, even people that make bad decisions, and
that many people make bad decisions. You know that we
will have a lot of people who say I can't
afford medical care because they don't save money. But they've
got a big screen TV in every room, and they've got,
you know, a car they can't afford that they're driving.
Speaker 4 (16:26):
They end up with the car that they can't afford,
and we end up paying.
Speaker 3 (16:28):
For the healthcare that they can't afford to The book
is Overcharged, Why Americans Pay Too Much for Healthcare?
Speaker 4 (16:35):
Professor Charles Silver, And.
Speaker 1 (16:37):
Everybody knows who this guy is.
Speaker 3 (16:38):
Come on, man with the Michael Barrier, Come on, Professor
Charles Silver is our guest. It's a subject of great
interest to me and too many of you.
Speaker 4 (16:50):
The book is.
Speaker 3 (16:50):
Called Overcharged, Why Americans Pay Too Much for Healthcare? He
is a law professor at the University of Texas at
Austin School of Law. And we ended the last segment
with the discussion that at the end of the day,
the allocation of scarce resources and who will make that decision.
(17:12):
We're back at that point again in every family. You know,
you got eight kids and you've got one chicken. Mom
says you're not getting a second piece. So there's some
cartilage left on that leg. If you're hungry, you'll eat that.
And there comes a point where we have to decide
(17:33):
with scarce resources, who will make the decision as to
where those resources will be deployed.
Speaker 4 (17:39):
Will it be the government or will it be the individual?
Speaker 3 (17:42):
And if it's the individual, there will be those who say, well,
I want as much as my neighbor has, Okay, we'll
earn the money to purchase that. Well, I don't earn
as much. I want to use the power of the
gun through at the direction of the government that I
either more of me than there of the rich people
I vote for. I want that well. The only alternative
(18:04):
is for the government to do it. Professor I harkened
back to a study, and it's been a while since
I read this book. It's interesting because I'm a believer
and let the marketplace decide. You know, healthcare is the
one area where we think everybody gets all the healthcare
they want, but we all end up paying for that.
We don't say everybody gets all the food they want,
(18:25):
or all the cars they want, or all the houses
they want, or all the clothes they want, but for
some reason, everybody gets all the healthcare they want, even
at the point that it's throwing good money after bad.
So socialist system the opposite of what I propose. In Sweden,
they did a study, and it was a multi decade
study you may be aware of it, on prostate cancer
in men, and they determined that out of I think
(18:50):
it was three thousand men who had prostate cancer who
were diagnosed with prostate cancer, and they chose not to
treat the prostate cancer. And they did about a twenty
five year study and the number of men who died
of untreated prostate cancer was something like thirty out of
three thousand. So they came to the conclusion with a government,
(19:14):
completely government run system, that with scarce resources, it does
not make sense for us to treat prostate cancer per
se because nobody, very few people are going to die
of prostate cancer. Let's spend our money on other things
that if we don't spend it there, you die.
Speaker 4 (19:32):
And it strikes me.
Speaker 3 (19:33):
That while that's the opposite of the capitalist system, there
does need to be an understanding that we're wasting a
lot of money on studies because and this gets to
the second point of what you've written a lot about
medical malpractice and the fear of medical malpractice.
Speaker 4 (19:51):
I don't think everybody.
Speaker 3 (19:52):
Needs a glaucoma test every time they go for their license,
but god forbid one person not be diagnosed with glaucoma.
We're practicing defensive medicine. We're over ordering tests, which is
a waste of our time and energy, but also money,
and we're not actually doing we're not engaged in what
(20:12):
I would consider smart effective healing because everyone is afraid
of being sued.
Speaker 4 (20:18):
And that has we get back to our point.
Speaker 3 (20:21):
The book is overcharged, Why Americans pay too much for healthcare?
I think that's a big portion of what we spend.
Your thought, well.
Speaker 5 (20:29):
I'm going to disagree with part of that, but I
agree with a lot of it as well. In my world,
when you have a self interested explanation or something, you
probably don't have to look very far for any other explanation.
Self interest usually is a pretty good explanation. And the reason,
you know, some people say, oh, the reason that doctors
(20:52):
overtreat is because they're afraid of being sued. Well, there's
a simpler self interested explanation, which is every time they
treat somebody, they make money, and until you take the
profit out of these services, which will never happen, it's
very hard to determine that they're actually engaging in any
(21:13):
real defensive medicine at all. There are lots of studies
that are out there now that have found.
Speaker 1 (21:19):
That, I mean, defensive medicine is kind.
Speaker 5 (21:22):
Of hard to define because it can be both it
can be both the provision of services that aren't needed
and the avoidance of services that are needed, because you
get sued when you do deliver services as well as
when you withhold them. So it's hard to figure out
exactly what's going on with defensive medicine. But as I said,
(21:44):
I don't think we really need to worry about it
very much because we have a self interested explanation, which
is that the services are profitable. And there's also you know,
doctors have a lot of confidence in their ability to
help people, and they have a very strong desire to
help people.
Speaker 1 (21:59):
Right, that's what it should be.
Speaker 5 (22:01):
You know.
Speaker 3 (22:01):
You remind me of another great document written in seventeen
seventy six, and that from a Scotsman named Adam Smith,
who famously said, it is not from the benevolence of
the butcher, or the brewer or the baker that we
expect our dinner, but from their regard to their own
self interest. And exactly self interest drives so many things.
(22:25):
That guy is not standing on his feet behind the
counter at the donut shop for so many hours and
didn't get there at two thirty this morning because he's
a nice guy.
Speaker 4 (22:34):
He wants to make a profit off the donuts.
Speaker 3 (22:36):
I get to enjoy the donuts in exchange for the
currency that I was given for the sweat of my brow.
Speaker 4 (22:42):
It works, and I think we have to return that
to the process. And I think that's where you and
I can agree.
Speaker 5 (22:49):
I think we do agree on that, but we also
agree that I mean, these social programs have fundamentally undermined
the incentive to save and to be self reliant.
Speaker 1 (23:04):
You know, the I think, you know, I constantly.
Speaker 5 (23:08):
Read articles about how many people are retiring and all
they have to live on is social security and medicare
They don't have much in the way of savings. And
people say, well, how could you possibly you know, let
that happen?
Speaker 6 (23:22):
Right?
Speaker 5 (23:22):
Why are you buying, as you put it, those you know,
big screen TVs for every room when you should be
saving for your later years. I think the answer is
that most people naively think, oh, the government's just going
to take care of me in my later years, so
I don't have to save, and they, you know, the
temptation to spend money now rather than later, it's always there.
(23:43):
Who wants to save? Saving is boring?
Speaker 1 (23:45):
Right?
Speaker 5 (23:47):
Consuming today is fun? So, you know, I think that
as long as we have these paygo programs where you
know you can keep getting money out above what you
put in, that the incentives to save will forever be undermined.
And that's a terrible thing, I think, because, as you said,
(24:08):
you know, we're just getting ourselves into this world where
each of us expects everybody else to pay for everything
that we need. If it's only healthcare, they still expect
to pay for everything that they want, and that just
drives costs through the roof without really any offsetting benefits
that make sense of it.
Speaker 3 (24:27):
Zoologists will tell you you are doing great harm by
domesticating certain breeds of animals, particularly if you intend at
some point to release them into the wild.
Speaker 4 (24:39):
You make them slaves.
Speaker 3 (24:40):
They lose the very abilities, and we've seen with evolutionary
studies that teeth are not as sharpenning longer, claws are
not as sharpenning more, they can no longer run as fast.
They grow to be like prison inmates, dependent on someone
else to provide for them, and I think that has
to be understood by people. Our guest is Professor Charles Silver,
(25:04):
who will be with us for one more segment. The
book is overcharged. Why Americans pay too much.
Speaker 1 (25:12):
That's it. Arrest me or take me to Texas. So
many gets out of this state.
Speaker 6 (25:17):
I think Michael Berry Robins show I like you.
Speaker 3 (25:23):
Professor Charles Silver of the University of Texas School of Law,
my alma mater, has graciously spent quite a bit of
time with us discussing an area of his academic expertise
and prowess. The book is Overcharged, Why Americans pay too
much for healthcare? And folks, I have to say, as
you've heard me say many times, politics is interesting, you know,
(25:48):
the rooting for your team versus that team, the Trump Dance,
the reds and Blues, and who shows up and only.
But my primary interest at the end of the day
is not my team winning and your team losing. The
primary interest is creating a structure where the individual can thrive,
where there is opportunity and fairness, safeguard's rule of law,
(26:11):
and that will, at the end of the day, advance humanity.
It always has. It's the only thing that does not government.
And so these sort of policy discussions, I understand are
probably less thrilling than my usual screaming and hollering about
this or that indignity of the day. But this is
what matters. This is why we get involved in campaigns,
(26:34):
is to take control of the government and get it
out of our lives and create safeguards and reduce regulation
and promote the rule of law so that hardworking people
can create enough John Gault style for the rest of
us to prosper. And this stuff matters. So that's why
we have these conversations. Professor Charlesolver, overcharged, why Americans pay
(26:56):
too much for healthcare?
Speaker 4 (26:57):
Professor Silver, I want you to be king for a day.
You have no.
Speaker 3 (27:03):
As this benevolent monarch, you have no political concerns. Reconstruct
our health care facility to provide an opportunity for the
most healing to occur and the individuals to take control
of their own healthcare.
Speaker 4 (27:18):
What does that look like?
Speaker 5 (27:22):
Wow, I'm nervous about being king for a day because
I don't believe in kings, I know, but I'll try.
I think we basically wipe away everything in terms of
these programs and the restrictive regulations. You know, have you
ever heard of a certificate of need law?
Speaker 1 (27:43):
I don't know. They're called con laws by for short,
but con.
Speaker 5 (27:47):
Laws regulate how many new healthcare providers can set up shops.
So if you want to open a hospital, you got
to get permission. Oh okay, I guess what the way
the common laws work. The existing hospitals have a vote
and whether you can open a new hospital, or like
giving McDonald's a vote on whether Burger King can open
(28:11):
a restaurant right across the street.
Speaker 1 (28:14):
It just doesn't make any sense.
Speaker 5 (28:15):
But that's the way I would get rid of all
of those supply constraining regulations, and I would get rid
of all of these programs Obamacare, Medicare, whatever, and I
would go to a very simple wealth distribution program. I'm
not sure exactly how much money it should be. That's
(28:36):
something that has to have some work done. But you
know we're currently spending if you put all the healthcare
programs together, you know, we're spending like seven eight ten
thousand dollars a person per you know, per American through
these programs. If we just took some of that money
and started plunking it into restricted healthcare savings accounts for
(28:59):
people year, you know, there's just a little bit more
that's put in. Pretty soon everybody would have enough money
to pay for their basic needs and to buy catastrophic insurance,
and I would let people buy just as much catastrophic
insurance as they want.
Speaker 1 (29:14):
I wouldn't have coverage mandates.
Speaker 5 (29:16):
You know, right now, if you want to buy a
policy on one of the exchanges and you're a young man,
you know you have to pay for annual mammograms, right,
but you're not getting mammograms because you're a man, right right,
So you know, I wouldn't force people to buy any
(29:37):
particular amount of coverage. And I would let insurance companies
limit the total payouts, which you know, that's.
Speaker 1 (29:44):
Really where things are screwed up right now.
Speaker 5 (29:47):
It's one of the areas, right they have to spend
unlimited amounts of money on people. I would let people
let design their own insurance programs, and I think that
you know, it's not going to work perfectly. Nothing ever
works perfectly, right, But it would work so much better
and be so much more efficient than the existing system,
and it'd be way more consumer friendly. And that's a
(30:10):
huge improvement because I don't know anybody who is happy
with the existing healthcare system. I mean, this terrible murder
that just occurred has brought to the surface the extraordinary
hatred that people have toward insurance companies. You know, that's
just one symptom. We're spending twice as much as any
(30:34):
other country on healthcare, and we're getting less and less
healthy every year. You know, our life expectancy is declining.
We're just doing everything wrong that we possibly can do.
So wipe the slate, get rid of all this stuff.
Start out with a really simple direct payment system and
a cash transfer system to deal with people who are
(30:55):
so poor that they can't even afford the basics, and
just be satisfied with that. I said, it's not gonna
be perfect, but it'd be hard to improve on all, right.
Speaker 3 (31:06):
Yeah, And to get outside the purview of what we've discussed,
but to speak more to the process that lands us
where we are.
Speaker 4 (31:15):
Our criminal justice system.
Speaker 3 (31:16):
We spend more on imprisoning and prosecuting and chasing down
bad guys in any other country in the world.
Speaker 4 (31:24):
And yes, I think we do.
Speaker 3 (31:25):
A far worse job, at less effective job than most
countries in the world.
Speaker 4 (31:30):
And I think much of that you can see.
Speaker 3 (31:33):
Some similarities and patterns that pervade those two industries. And
by the way, then we could move over into public
education and education generally.
Speaker 1 (31:44):
There are a.
Speaker 3 (31:45):
Number of different applications for where this process has gone wrong,
and it is frustrating. I very much appreciate your time, professor,
feel the better for it. The book is overcharged Why
Americans pay too much for healthcare? Professor Charles Silver of
(32:08):
the University of Texas.
Speaker 1 (32:09):
School of Law. Thank you, sir, Thank you, Michael pleasure.
Speaker 3 (32:13):
And with that, might I suggest to each and every
one of you that while politics is an interesting undertaking,
and it is you know, winning elections, and he said this,
and we're going to show him, and.
Speaker 4 (32:27):
You know, it's a battle royale, and you.
Speaker 3 (32:29):
Know I argued with my cousin at the Thanksgiving table,
at the end of it all, the reason for the arguments,
reason for the elections should be very redemptive, very practical,
not just existential, not just ideological. They're real to your life,
(32:54):
and that is creating a governmental system where individuals are
free to thrive. Government is not just. Government is not merciful.
Government is not protective, It is not good. Government is clunky,
(33:15):
it's inefficient. If you've stood in line of the DPS
office to get your driver's license and thought to yourself,
you could move this thing along. If you've seen someone
who is on the clock and doesn't care about results.
If you've seen the worst of government in every aspect,
whether it's the inspector who doesn't seem to care, that
(33:36):
they're coming back and adding these regulations that are going
to cost this much more for you to build this,
and now you're going to walk away from the project
and lead the property vacant, and that's not good for anybody.
Speaker 1 (33:47):
These are the.
Speaker 4 (33:48):
Things that we should spend our time with.
Speaker 3 (33:51):
And I say this because politics has become sport and
it's become for many.
Speaker 4 (33:56):
People their favorite hobby.
Speaker 3 (33:58):
But let's not lose track of what we're trying trying
to do here, which is literal, not to exaggerate, to
save our country.
Speaker 4 (34:04):
Exelman Els has left the building.
Speaker 1 (34:07):
Thank you, and good night.
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