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December 12, 2024 • 52 mins
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Speaker 1 (00:00):
The Michael Berry Show, as some of you know, because
I talk about my personal life on the air. It's
all I got to talk about, and I share how
I interact with the policies and politics that we talk about,
because at the end of the day, these aren't academic discussions. Right.
If the government takes over our health care, that's going

(00:22):
to affect you. And just because you're young and healthy
and haven't needed health care yet or recently, you don't
realize that, and you see it as some sort of
arcane or ethereal existential discussion. But that's not where it
is for me. I have a brother who died of
the clot shot, a perfectly able bodied law enforcement officer

(00:45):
with over thirty years who died of the clot shot
January twenty fifth, twenty twenty two. My father is eighty four,
and since he was twenty years old and had to
be discharged from the Coast Guard on his deathbed with
a severe case of diabetes, and they didn't know how

(01:06):
to treat it back then, they sent him home to die,
and he read and experimented, and here we are, he's
eighty four and still alive, still battling diabetes. By the day.

Speaker 2 (01:16):
He is.

Speaker 1 (01:18):
In constant contact with doctors, and many of them have
told me, your dad knows more about diabetes than diabetes
doctors do, because in an era before we had proper insulin,
he was managing his blood sugar that's unheard of. And
he still has his vision in all ten of his
fingers and toes well. He's a man of great self
discipline and the willingness to experiment on himself and get

(01:40):
enough sleep and not drink and you know, do the
things that are necessary. And then, of course my mother,
five years younger than him. My father was supposed to
go first, and my mother would nurse him until the end.

Speaker 2 (01:52):
Of his life.

Speaker 1 (01:53):
And she up and passes on us. And she ended
up having als that basically just eventually took over her
body and left her unable to breathe. Her lungs just
wouldn't function, and it was a horrible, horrible way to go.
She died in hospice at our home. I have been

(02:14):
in and out of hospitals just with these things so
many times over the last few years that I have
come to learn a lot about the medical care system.

Speaker 2 (02:29):
You know.

Speaker 1 (02:29):
I had a minor stroke on August first, twenty sixteen.
I you know, we've all had our medical issues. I'm
much better now about taking care of my health and
getting my checkups and all that. But the policy issue
of how we deliver healthcare in a marketplace of people

(02:52):
trying to heal you and provide wellness and prevent all
these things, it's gotten. It's all messed up, and I
don't I think people really even understand why it's all
messed up. And so today I would like to step
back from the news of the day and address this.

(03:13):
There is a fellow who has been highly recommended when
I bring these questions up, named Charles Silver. He is
the McDonald Endowed Chair of Civil Procedure at the University
of Texas at Austin School of Law. I don't know
if he was there when I was there in the
mid nineties. I don't know him, but his work has

(03:35):
been widely widely discussed, particularly his book Overcharged, Why Americans
pay too much for healthcare. Professor Silver, welcome to the program.

Speaker 2 (03:51):
Thank you, Michael, pleasure to be here.

Speaker 1 (03:52):
I must first ask you if you were on faculty
from ninety three to ninety six when I was there.

Speaker 2 (04:01):
I was I started teaching at Texas in nineteen eighty seven.

Speaker 1 (04:04):
Oh well, okay, Well, I was a Lino Graula acolyte
and I was the first crop. There were two of
us that were sent to England to get an LLM degree.
So I was kind of checked out after my second year.
Once I had my offer, I was kind of checked out.
But I'm sorry that I never met you. I had

(04:28):
a wonderful experience at the University of Texas School of Law.
It's a great university law school, and I am the
better for it. So I think a lot of you
for being on factory there. It's a great institution.

Speaker 2 (04:42):
Let's thank you. I'm sorry I didn't get to meet
you when you were a student.

Speaker 1 (04:46):
Indeed, the book overcharged why Americans pay too much for healthcare?
If somebody says, Michael, I'm going to come back and
listen on the podcast later, but give me the one
minute answer, and then let's get granular and dig into this.
What's the one minute answer as to why we pay
too much for healthcare?

Speaker 2 (05:09):
The one minute answer We rely far too heavily on
third party payment arrangements, which means insurance companies, Medicare, Medicaid, Trycare, Va,
whatever they happen to be instead of paying for health
care directly the same way we pay for pretty much

(05:30):
everything else food, cars, housing, We pay for the vast
majority of things directly, meaning we pay for them ourselves,
and we don't have the problem of excessive spending or
inflation or costs, or hidden bills or surprise bills or
phony charges. All that works really well. The one exception

(05:53):
is the healthcare sector, where we rely very very extensively
on third parties to pay for things, and that just
screws everything up. Now. The other thing is we have
way too much governmental involvement in the healthcare sector. There
are lots and lots of regulations that make things worse
for consumers. By and large, the regulations have the purpose

(06:16):
of protecting the producers, not the consumers, so we should
do a lot less in that way.

Speaker 1 (06:26):
You did that. You were technically finished at fifty eight seconds.
You added an addendum to the end that I will
admit I will it is admissible in this case. But
you achieved the fifty eight seconds. I'm quite impressed that
you did that. So let's start drilling down on these things.

(06:47):
I've got a minute left in this segment, but I
have dedicated some time to talk about this because I
think a lot of people are frustrated, especially when they
start getting all these bills and they go to the
emergency room and the place is packed, and then they
can't get in to see a doctor, and then they wonder,

(07:08):
you know, why does something cost ten thousand dollars that
took twenty minutes. It just there's nothing else that requires this.
It all seems so frustrating to people, and I would
like to drill down and get into the actual reasons
why this works. Let me let me start by prefacing,

(07:31):
and we'll get to this in the next segment, because
I don't want to have to cut you off. I
want to first talk about what if we were to
do a zero based budget, we were to go back
to John Locke's state of nature, and let's start all
over and have a cash only health delivery system. Let's
do away with insurance, and let's talk about who the

(07:53):
winners and losers out of that would be. And more importantly,
if I'm if I'm a consumer of health services, because
I don't believe that healthcare is a right. If I'm
a consumer of health services, would this be better or
worse for me, so hang tight right there. Our guest
is Professor Charles Silver. I encourage you to read the

(08:14):
book Overcharged, Why Americans Pay too Much for Healthcare?

Speaker 2 (08:21):
Coming up?

Speaker 3 (08:23):
This is the Michael Berry Show, Locked and Loaded, Loaded.

Speaker 1 (08:34):
Professor Charles Silver is our guest, and as promised at
the end, I've given him a moment to consider. Professor,
what if we go back the book is Overcharged Why
Americans pay too much for healthcare? What if we did
away with all insurance and we went cash only. How
would that change things?

Speaker 2 (08:53):
It would change a lot of things for the better,
but some things for the worse. So a lot of
things would be better. You know. We wouldn't have to
worry about things like surprise medical bills where you don't
even know what something is going to cost when you
get the service delivered. There's actually a very large retail
health sector. So if you want to get laser eye surgery,

(09:16):
for example, you have to pay for that yourself because
it's not covered by insurance typically. But you know what,
it's actually very affordable and the price for laser surgery.
Are you ready for this? The price has substantially declined
since Lasik was developed, and it's gotten much better too.
There are new forms of LASIK and all that has

(09:39):
happened because there is no overlay of insurance. Where where
in the healthcare sector, except in the private payment sector
can one find prices that have declined. Now. There are
no hospital services that I'm aware of that cost less
now than they used to. But in the private sector

(10:00):
where we purchase cosmetic surgery, I mentioned Lasich. There's also
the Surgery Center of Oklahoma, which takes operates on a
cash basis. But there are lots of services that people
can buy directly, and those things that part of the
market works incredibly well with. As I said, we don't
have surprise bills. Everybody knows that they're going to pay

(10:20):
before the service is delivered, and nobody gets billed for
more than the price. The prices are posted. We don't
have to have a you know, in the hospital sector,
we have this federal Transparenity rule transparency rule that hospitals
routinely ignore that's supposed to require them to post their prices.
But in the retail sector, we don't have that, and

(10:41):
everybody posts their prices anyway. So a lot of things
would work better if we did that. But the one
thing that would work. Worse would be emergencies where you're
facing a risk of a catastrophic cost that you know
people just can't afford to bear on their own. That's

(11:01):
where insurance has a role to play.

Speaker 1 (11:04):
Catastrophic costs, Yeah, professor, I have long advocated that we
should if people would understand. For instance, I only have
liability insurance on my vehicles, and people say you have
to No, no, no, I pay cash for my vehicles. The
only reason people are over insured in most cases is
because the person holding the loan wants you to have

(11:26):
insurance for more than the value of what they're of
what they've loaned you money for in case the thing
gets burned down or trash, they want their money once.
You don't have to do that. In my opinion, I'm
a safe driver. I've never met an insurance claim. In
my opinion, it's a bad business deal. So what I
tell people to do is get catastrophic health insurance so

(11:49):
when it hits fifteen thousand and up, it's good. And
then pay cash. And you'll be shocked how many doctors
will discount what you get and they're happy to have
the cash. I go to a doctor, doctor named Mary
Tally Boden for all my upper respiratory stuff. And she's
a cash only doctor, which, as you know, a lot
of people are going to and you go in and

(12:09):
you make your payment and it's insanely cheap, and then
there's no documentation. Later there's no you know, insurance letter arrives.
Do we pay this? No, we wait to pay this.
She's happier. She doesn't have to have a bunch of
billing clerks. You literally pay the same way if you
bought yogurt there. I think this is the answer, Professor.

Speaker 2 (12:28):
Well, I agree with you because I go to a
doctor who works on the same basis. So my doctor
I pay a monthly subscription fee too, but I can
go as many times as I want. You know, I
don't need to go all the time, fortunately, but if
I need to go, she usually can see me either
that day or the next day, and I get some

(12:50):
tests performed in house at no charge. And it's a
great working arrangement. Like you, I don't get it. I
don't worry about my insurance company, you know, not paying
for something. So I think I agree with you. The
cash payment is a very good approach for basic healthcare.

Speaker 1 (13:12):
So let's have a little history lesson. Professor Charles Silver
is our guest. The book is called Overcharged, Why Americans
paid too much for healthcare. Let's go back to wherever
the starting point is you want it to be, nineteen
fifty or nineteen seventy. Where did it start going wrong?
Because we all know it's wrong.

Speaker 2 (13:31):
Now.

Speaker 1 (13:31):
Where did it start going wrong?

Speaker 2 (13:34):
Oh, that's easy. It started going wrong in the mid
nineteen sixties when Medicare and Medicaid came online. In my book,
I show how doctors and hospitals fees changed after Medicare
and Medicaid took effect in nineteen sixty five, and basically,
both of those statutes initially let doctors and hospitals charged

(13:58):
whatever they wanted for services, and so, not surprisingly, they
started raising their rates immediately, I mean really immediately after
the enactment of those programs, we were beset with health
care inflation that exceeded the real growth rate of the GDP,
and we have been struggling with healthcare inflation ever since.

(14:21):
But everything about the arrangement is wrong. I mean, who
in their right minds, let's people who are selling things
set their own prices without any market constraints. I mean,
that's a recipe for disaster, right. And then, of course
that couldn't last forever. So the government eventually did get
into the price setting business in Medicare and medicaid. But

(14:42):
of course we all know that government price setting is terrible.
It never works properly. It's really hard to set good prices,
to set prices accurately. And moreover, the government really doesn't
have the right set of interests. You know, I want
just the price that matters to me. It's the convenience, right.

(15:02):
How long do I have to wait to see my doctor?
How friendly is my doctor, How good is my doctor?
There are all these things. Different doctors should have different prices,
and markets can work all that stuff out, but governments
just are notoriously unable to do that. And so as
a result, we've had this terrible system. And because it's

(15:23):
so terrible, it's constantly in need of patching. I mean,
every time I turn around, there's a new bill, a
new proposal being put on the table for some kind
of regulation to fix a problem that only exists because
the government created it. It's never going to be fixed.
It's impossible to fix it. We really need to just

(15:46):
scrap these arrangements and go back to a simple cash
based system for fundamental care, and then things will start.
It will immediately be out of the spending crisis. The
prices will moderate because hospitals and doctors and drug companies
and all that will have to deal with the realities
of the limited budgets of consumers. They'll also have to

(16:08):
face competition. That's hugely important. You know, one I mentioned
the retail health sector. You know, one of the reasons
lasik is cheap is because there are a lot of
laser providers and any ophthalmologists can enter the field who
wants to. So there's a lot of competition, and competition
is good for consumers. So we need to get rid

(16:29):
of these competition frustrating regulations. Let's increase the supply. Let
you know, foreign doctors who can pass American exams come
in and treat people. We need to just open the
floodgates for providers because we have this artificially created shortage.
You know, that's one of the waves that doctors and

(16:49):
hospitals have increased their revenues. It's by preventing new entrants
from coming in and you know, outcompete. So we have
to get rid of all that.

Speaker 1 (17:00):
Professor Charles Silver at the University of Texas School of Law,
my alma mater, is our guest. His book is Overcharged,
Why Americans pay to dang much for healthcare? I added
the dang, but I think we all feel it more
with Professor.

Speaker 2 (17:18):
Silver coming up to.

Speaker 1 (17:23):
Professor Charles Silver is our guest. He's a professor at
the University of Texas School of Law, which I happened
to believe is fantastic because I'm a graduate of same.
His book is Overcharged, Why Americans Pay too Much for Healthcare?
You mentioned that the problem began with Medicare Medicaid in

(17:44):
the sixties, part of Lyndon Johnson's 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

(18:05):
go in and review every expense, everything that comes in,
and all that this 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,

(18:26):
and sometimes I stay involved for a little while just
to see, you know, kind of what they're working through.
It's amazing 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, and people had
no idea, And now, all of a sudden, I've been,
you know, dumped into the Medicare playground. And I don't

(18:46):
know why, how does this even work?

Speaker 2 (18:51):
Too well? I just I recently hit that age myself,
so I can sympathize with those whose mailboxerre 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,

(19:12):
although that is very expensive and far too comprehensive. You know,
it's because of the mandates regarding what employer sponsored coverage
has to include 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

(19:34):
program that was designed to 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, way smaller than the amount

(19:58):
that they get out for most people. 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. Well, you know,
that's a nice arrangement. I'd like to have that, But
the problem is somebody. The money to pay for all

(20:18):
those benefits has to come from somewhere, and in only
only two sources. One is general 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,

(20:42):
back when Bush two was president, right, 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

(21:05):
paying twenty five percent of the cost. But 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 its actual cost, and the result of that in

(21:28):
the long run has to be deficit increases and inflation increases.
There's just no getting around that.

Speaker 1 (21:37):
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
Leno Graiaz. You'd probably understand where my views are with

(21:58):
regard to politics and the role of the government 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

(22:19):
in fact, what goes with that is, 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

(22:40):
beyond healthcare and we've moved into a sort of totalitarian
authoritarian control of the individual.

Speaker 2 (22:48):
Well, you're certainly singing my song because you know you're
a libertarian. I'm an adjunct scholar at the Cato Institute.
I don't think it gets much 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

(23:15):
of the story, but I think governmental ineptitude is probably
a much bigger part of the story. 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

(23:39):
why market forces are so important, because market forces are
constantly rewarding providers for figuring out how to serve patients better. Right,
that's how you can get business. If you can figure
out how to serve your customers better, then you'll get
more customers. And that's just something that requires people who

(24:01):
know the nuts and bolts really well to be constantly
reflecting on how they're doing their jobs. Right. 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

(24:22):
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 authorization requirements, surprise bills,
these things called facility fees that you know, you go
to an emergency room, the doctor says, oh, you've got
a fever, take some aster and go home, and then

(24:42):
you get a bill for ten thousand dollars because you
literally because you walked in the front doors. 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 delivered, and it

(25:05):
does it in stupid ways because it's.

Speaker 1 (25:08):
Hard to do it right 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 2 (25:21):
Fellers and to the Michael Berry Show, good not.

Speaker 1 (25:30):
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

(25:50):
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

(26:12):
guest professor. 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

(26:33):
after another, and then they pass and then you kick
in the 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

(26:56):
you're willing to assume. Right, if you're never going to
need a doctor, then you don't 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 is that going wrong today? Because

(27:19):
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.

Speaker 2 (27:30):
Oh, I agree that I think that story is right.
There are a bunch of thoughts that it prompts. 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. You know. One is
every moral theory that I know of says you move

(27:53):
money from richer people to poorer people. Well, older people
are wealthier younger people. That shouldn't 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,
much wealthier than younger people who are struggling, you know,

(28:14):
raising families, you know, just getting jobs, dealing with college
debt and all that stuff. 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,

(28:36):
excuse me, the system really deserves people because it eliminates
all caps on spending. You were talking about end of
life care and how we spend so much money in
the last year or two of people's lives. Well, if
people had to spend their own money, nobody would spend

(28:57):
an infinite amount in their last two years on 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 they would have to make. Well, today,

(29:18):
because we 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. We get no bang for
the buck. You know, we have people, literally we have
people who are receiving cancer treatments, new cancer treatments that

(29:39):
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 whole month. These
things just make no sense. But the government, the government

(30:01):
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 spends endless amounts

(30:25):
of money because it's other people's money. So why does
the government care? Right? And you know, we just have
to come back to the world in which people are
responsible for their own end of life care. You know,
it's it's it's a sad thing, but it's true. We
will all die at some point, and the fact that

(30:48):
we will all die at some point affects a thousand
decisions that each of us makes. Right, When am I
going to stop working? Well, if I'm thinking I don't
have much longer to live, I had, probably we will
stop working so I can spend 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

(31:10):
all die, it affects, as I said, thousands 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

(31:32):
needs to be made, and it needs to be made
not 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 when making these kinds of decisions. So,

(31:55):
you know, we just have to get the government out
of this business. What I have proposed is that we can.
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

(32:16):
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
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

(32:40):
that they can use for this purpose. You could put
it into a restricted medical account if you wanted. But
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. Just people make
decisions on themselves with their own money, and life goes forward.
I think if we did that, the healthcare system would

(33:02):
operate much more efficiently. Well.

Speaker 1 (33:04):
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, 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. They end

(33:27):
up with the car that they can't afford, and we
end up paying for the health care that they can't afford.
The book is Overcharged, Why Americans Pay Too Much for Healthcare?
Professor Charles Silver. But everybody knows who this guy is.

Speaker 2 (33:40):
Come on, man, mit the Michael Berry, Come on.

Speaker 1 (33:49):
Professor Charles Silver is our guest. It's a subject of
great interest to me and to many of you. The
book is 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,

(34:12):
the allocation of scarce resources and who will make that decision.
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.

(34:34):
And there comes a point where we have to decide,
with scarce resources, who will make the decision as to
where those resources will be deployed. Will it be the
government or will it be the individual? 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

(34:54):
the money to purchase that. Well, I don't earn as much.
Want to use the power of the gun at the
direction of the government that I they're more of me
than there are of the rich people I vote for.
I want that well. The only alternative is for the
government to do it. Professor I. Hearken back to a study,
and it's been a while since I read this book.

(35:17):
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, 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

(35:38):
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 it was three thousand men
who had prostate cancer who were diagnosed with prostate cancer

(36:01):
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, completely government run system,
that with scarce resources, it does not make sense for

(36:24):
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. And it strikes me that
while that's the opposite of the capitalist system, there does
need to be an understanding that we're wasting a lot

(36:46):
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. I don't think
everybody needs a glaucoma test. Every time they go for
a you know, their license, but God forbid one person
not be diagnosed with glaucoma. We're practicing defensive medicine. We're

(37:07):
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 I would consider smart effective
healing because everyone is afraid of being sued. And that
has we get back to our point. The book is overcharged.
Why Americans pay too much for healthcare? I think that's

(37:29):
a big portion of what we spend.

Speaker 2 (37:31):
Your thought, well, 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
for 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,

(37:55):
the reason that doctors 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 real defensive medicine at all. There

(38:21):
are lots of studies that are out there now that
have found that, I mean, defensive medicine is kind 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

(38:42):
you withhold them. So it's hard to figure out exactly
what's going on with defensive medicine. But as I said,
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

(39:03):
help people.

Speaker 1 (39:04):
Right at least that's what it should be.

Speaker 2 (39:06):
You know.

Speaker 1 (39:06):
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.

(39:30):
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. He wants to make a profit off
the donuts. I get to enjoy the donuts in exchange
for the currency that I was given for the sweat
of my brow. It works, and I think we have
to return that to the process. And I think that's

(39:51):
where you and I can agree.

Speaker 2 (39:54):
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, you know,
the I think you know, I constantly read articles about

(40:14):
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? Right?
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

(40:35):
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.
Who wants to save? Saving is boring, right? Consuming today
is fun? So you know, I think that as long

(40:57):
as we have these paygo program 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,
you know, we're just getting ourselves into this world where

(41:17):
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 (41:32):
Zoologists will tell 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 1 (41:44):
You make them slaves. They lose the very abilities, and
we've seen with evolutionary studies that teeth are not as
sharp any longer, claws are not as sharp any more,
they can no longer run as fast, they grow to
be like prison inmates, depend on someone else to provide
for them, and I think that has to be understood

(42:06):
by people. Our guest is Professor Charles Silver, who will
be with us for one more segment. The book is Overcharged?
Why Americans pay too much for that said?

Speaker 2 (42:17):
Arrest me or take me to Texas because I don't
ready to get out of this state.

Speaker 1 (42:22):
I think Michael Berry Rocks show I like you. 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

(42:45):
much for healthcare? And Folks, I have to say, as
you've heard me say many times, politics is interesting, you know,
the rooting for your team versus that team, the Trump Dance,
the Reds and Blues, and who shows up. But my
primary interest at the end of the day is not
my team winning and your team losing. My primary interest

(43:07):
is creating a structure where the individual can thrive, where
there is opportunity and fairness, safeguard's rule of law, 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

(43:28):
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,
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

(43:49):
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
too much for healthcare? Professor Silver, I want you to
be king for a day. You have no as this

(44:10):
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. What does that look like?

Speaker 2 (44:28):
Wow, I'm nervous about being king for a day because
I don't believe in kings, I know, but no, 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? I don't know.

(44:50):
They're called con laws by for short, but con laws
regulate how many new healthcare providers can set up shops.
So if you want to open a hospital, you got
to get permission. But guess what the way the con
laws work, the existing hospitals have a vote and whether

(45:11):
you can open a new hospital or not. They're like
giving McDonald's a vote on whether Burger King can open
a restaurant right across the street. It just doesn't make
any sense, 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,

(45:33):
and I would go to a very simple wealth distribution program.
I'm not sure exactly how much money it should be.
That's 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

(45:56):
through these programs. If we just took some of that
money and started plunking it into restricted healthcare savings accounts
for people, so every 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

(46:17):
just as much catastrophic insurance as they want. I wouldn't
have coverage mandates. 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 mamograms because

(46:38):
you're a man, right right, So you know, I wouldn't
force people to buy any particular amount of coverage, and
I would let insurance companies limit the total payouts, which
you know, that's really where things are screwed up right now.
It's one of the areas, right they have to spend
unlimited amounts of money on people. I would let people

(46:59):
let design their our own insurance programs. And I think
that you know, it's not gonna 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
huge improvement because I don't know anybody who is happy

(47:21):
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
other country on healthcare, and we're getting less and less

(47:43):
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 trainansfer a system to deal with people who
are so poor that they can't even afford the basics,

(48:05):
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 1 (48:12):
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. Our criminal justice system. We spend more
on imprisoning and prosecuting and chasing down bad guys in
any other country in the world, and yet I think
we do a far worse job, at less effective job

(48:35):
than most countries in the world. And I think much
of that can you can see some similarities and patterns
that pervade those two industries. And by the way, then
we could move over into public education and education generally.
There are a number of different applications for where this
process has gone wrong, and it is frustrating. I very

(49:00):
much appreciate your time, Professor. I feel the better for it.
The book is Overcharged Why Americans pay too much for
health care? Professor Charles Silver of the University of Texas
School of Law.

Speaker 2 (49:16):
Thank you, sir, Thank you, Michael pleasure.

Speaker 1 (49:19):
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 you know, it's
a battle royale, and you know I argued with my
cousin at the Thanksgiving table, at the end of it all,

(49:43):
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, and that is creating a

(50:04):
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, it's inefficient. If
you've stood in line at the DPS office to get

(50:26):
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 they're coming back
and adding these regulations that are going to cost this

(50:46):
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. These are
the things that we should spend our time with. And
I say this because politics has become sport and it's
become for many people their favorite hobby. But let's not
lose track of what we're trying to do here, which

(51:07):
is literal, not to exaggerate, save our country.

Speaker 2 (51:11):
And gentleman Elus has left. Nay, thank you, and good night.

Speaker 1 (51:17):
If you like the Michael Berry Show and podcast, please
tell one friend, and if you're so inclined, write a
nice review of our podcast. Comments suggestions, questions, and interest
in being a corporate sponsor and partner can be communicated
directly to the show at our email address, Michael at

(51:38):
Michael Berryshow dot com, or simply by clicking on our website,
Michael Berryshow dot com. The Michael Berry Show and Podcast
is produced by Ramon Roeblis, the King of Ding. Executive
producer is Chad Knakanishi. Jim mud is the creative director.

(52:02):
Voices Jingles, Tomfoolery and Shenanigans are provided by Chance McLean.
Director of Research is Sandy Peterson. Emily Bull is our
assistant listener and superfan. Contributions are appreciated and often incorporated
into our production. Where possible, we give credit. Where not,

(52:25):
we take all the credit for ourselves. God bless the
memory of Rush Limbaugh. Long live Elvis, be a simple
man like Leonard Skinnard told you, and God bless America. Finally,
if you know a veteran suffering from PTSD, call Camp
Hope at eight seven seven seven one seven PTSD and

(52:50):
a combat veteran will answer the phone to provide free counseling.
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