December 11, 2024 • 33 mins
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Speaker 1 (00:02):
It's that time time time, time, Luck and load. The
Michael Verie Show is on the air. Professor Charles Silver
(00:23):
is our guest.
Speaker 2 (00:23):
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 same. 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
(00:45):
Great Society, which turned.
Speaker 3 (00:46):
Out not to be.
Speaker 2 (00:47):
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 involve So my dad's
eighty four, my mom recently passed, and I go in
and review every expense, everything that.
Speaker 3 (01:06):
Comes in and all that this whole Medicare thing.
Speaker 2 (01:09):
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 to people that, all
(01:30):
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. 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 4 (01:50):
Too well?
Speaker 5 (01:51):
I just I recently hit that age myself, so I
can sympathize with those whose mailbox are crammed with Medicare
advantage flowers 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 too comprehensive. You know,
(02:16):
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 succeed by massively inflating the deficit.
(02:38):
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
that they get out for most people.
Speaker 4 (02:58):
Now, there are obviously exceptions to.
Speaker 5 (02:59):
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
those benefits has to come from somewhere, and it only
(03:21):
only two sources.
Speaker 4 (03:21):
One is general.
Speaker 5 (03:22):
Tax revenue, so they use money in addition tax revenue
in addition to the employee tax to fund the program.
Speaker 4 (03:30):
And the other is deficit spending.
Speaker 5 (03:33):
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 he created Medicare part D,
the Prescription Drug Benefit Program. Well, the premiums even initially
for that program, we're only set at fifty.
Speaker 4 (03:53):
Percent of the estimated cost.
Speaker 5 (03:55):
Now they're down to twenty five percent of the estimated cost,
which means everybody but he loves Medicare party because it's
a great deal, right, I'm only 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.
Speaker 4 (04:13):
And the same thing.
Speaker 5 (04:13):
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 the long run has to be deficit increases and
inflation increases.
Speaker 4 (04:33):
There's just no getting around that.
Speaker 2 (04:35):
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
(04:57):
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,
(05:20):
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
(05:42):
totalitarian authoritarian control of the individual.
Speaker 5 (05:47):
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
(06:13):
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
(06:37):
why market forces are so important, because market forces are
constantly rewarding providers for figuring out how to serve patients better.
Speaker 4 (06:48):
Right, that's how you can get business. If you can.
Speaker 5 (06:50):
Figure out how to serve your customers better, then you'll
get more customers. And that's just something that requires people
who know that nuts and bolts really well to be
constantly reflecting on how they're doing their jobs.
Speaker 4 (07:05):
Right.
Speaker 5 (07:06):
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
(07:29):
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 you get a build for ten thousand dollars
because you literally because you walked in the front doors.
Speaker 4 (07:45):
It's just like a.
Speaker 5 (07:47):
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 regularly the way healthcare is delivered, and it does
it in stupid ways because it's hard to do it right.
Speaker 2 (08:08):
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 4 (08:20):
And the Michael Berry Show good not.
Speaker 2 (08:27):
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
(08:47):
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,
(09:10):
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
(09:32):
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
(09:53):
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 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.
Speaker 3 (10:13):
Where is that going wrong today?
Speaker 2 (10:15):
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. 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.
Speaker 5 (10:34):
Fan of taxing people who are relatively young to provide
benefits to people who are relatively old. That stricks me.
Is wrong on a variety of levels, you know. One
is every moral theory that I know of says you
move money from richer people to poorer people. Well, older
(10:55):
people are wealthier than younger people. That shouldn't be surprising
to anybody. They've had their lives to work right and saved.
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,
raising families, you know, just getting jobs, dealing with college
(11:15):
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,
excuse me, the system really deserves people because it eliminates
(11:42):
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.
Speaker 4 (11:50):
Well, if people.
Speaker 5 (11:52):
Had to spend their own money, nobody would spend 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,
(12:15):
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.
Speaker 4 (12:28):
We get no bang for the buck.
Speaker 5 (12:30):
You know, we have 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.
Speaker 4 (12:42):
And it's not even a good month.
Speaker 5 (12:44):
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.
Speaker 6 (12:55):
These things just make no sense.
Speaker 5 (12:56):
Right. But the government, the government cannot make the those decisions. Literally,
it cannot because the moment the government starts talking about
rationing care, everybody loses their minds.
Speaker 4 (13:09):
And you don't want to be.
Speaker 5 (13:10):
The politician that they're rallying against. Right, So the government
simply ignores the need to make these decisions and just
spends endless amounts of money because it's other people's money.
Speaker 6 (13:24):
So why does the government care?
Speaker 4 (13:25):
Right?
Speaker 5 (13:28):
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 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 (13:48):
Decisions that each of us makes.
Speaker 5 (13:50):
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 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.
Speaker 6 (14:06):
Some point we will all die, it affects.
Speaker 5 (14:10):
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 needs to be made,
(14:30):
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.
Speaker 4 (14:39):
There's no way the government's going to make a good decision.
Speaker 5 (14:41):
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.
Speaker 6 (14:51):
So, you know, we just have.
Speaker 5 (14:52):
To get the government out of this business. What I
have proposed is.
Speaker 4 (14:59):
That we can.
Speaker 5 (14:59):
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, We're not going to be
having sick people dying in the streets because they can't
(15:22):
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.
Speaker 4 (15:32):
You provide everybody with.
Speaker 5 (15:34):
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 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 4 (15:51):
It just people make.
Speaker 5 (15:52):
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 6 (16:01):
Well.
Speaker 2 (16:01):
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
(16:24):
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 Silverman.
Speaker 4 (16:35):
But everybody knows who this guy is.
Speaker 3 (16:37):
Come on man with the Michael Berry, come on.
Speaker 2 (16:42):
Law professor at the University of Texas at Austin School
of Law. And we ended the last segment with a
discussion that at the end of the day, 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 got one chicken. Mom says,
(17:07):
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
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
(17:28):
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.
Speaker 3 (17:37):
Well, I don't earn as much.
Speaker 2 (17:40):
I want to use the power of the gun through
at the direction of the government, that I either more
of me than there are of the rich people I
vote for. I want them well. The only alternative is
for the government to do it. Professor I Harken back
to a study, and it's been a while since I
read this book. It's interesting because I am a I'm
(18:00):
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 good money after bad.
Speaker 3 (18:20):
So socialist system the opposite of what I propose.
Speaker 2 (18:23):
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, and they chose
not to treat the prostate cancer, and they did about
(18:47):
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 us to treat prostate
(19:07):
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 of money on studies because
(19:30):
and this gets to the second point of what you've
written a lot about medical malpractice and the fear of
medical malpractice.
Speaker 3 (19:36):
I don't think everybody.
Speaker 2 (19:37):
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
(19:57):
I would consider smart, if active 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 a big portion
of what we spend.
Speaker 5 (20:12):
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,
(20:36):
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 medice and at all.
(21:01):
There 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
(21:23):
when 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
(21:43):
help people.
Speaker 3 (21:44):
Right at least that's what it should be.
Speaker 4 (21:47):
You know.
Speaker 2 (21:47):
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 exactly. Self interest drives so many things. That
(22:11):
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 where you and
(22:32):
I can agree.
Speaker 5 (22:34):
I think we do agree on that, but we also
agree that I mean, these social programs have fundamentally undermined
the incentive.
Speaker 4 (22:45):
To save and to be self reliant.
Speaker 5 (22:50):
You know, the I think you know, I constantly 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 4 (23:07):
Right?
Speaker 5 (23:07):
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.
(23:29):
Who wants to save? Saving is born right? Consuming today
is fun. So, you know, I think that as long
as we have these pay go 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
(23:51):
that's a terrible thing, I think, because as you said,
you know, we're 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.
Speaker 4 (24:07):
That just drives costs through the roof.
Speaker 5 (24:09):
Without really any offsetting benefits that make sense of it.
Speaker 7 (24:12):
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 3 (24:24):
You make them slaves.
Speaker 2 (24:26):
They lose the very abilities, and we've seen with evolutionary
studies that teeth are not as sharpenny 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.
Speaker 3 (24:43):
And I think that has to be understood by people.
Speaker 2 (24:47):
Our guest is Professor Charles Silver, who will be with
us for one more segment. The book is overcharged, Why
Americans pay too much?
Speaker 4 (24:56):
Else, that's either risk me or take me to take
talk about it. He gets out of this state, I think,
Michael Barry robs I like it.
Speaker 2 (25:08):
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,
(25:32):
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. My
primary interest is creating a structure where the individual can thrive,
where there is opportunity and fairness, safeguard's rule of law,
(25:55):
and that will, at the end of the day, advance
humanity 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,
(26:19):
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 Galt 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
(26:40):
too much for healthcare?
Speaker 3 (26:42):
Professor Silver, I want you to be king for a day.
You have no.
Speaker 2 (26:47):
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 3 (27:03):
What does that look like?
Speaker 5 (27:06):
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.
Speaker 4 (27:24):
You know, have you ever heard of a certificate of
need law? I don't know.
Speaker 5 (27:28):
They're called con laws 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. Oh okay, I guess what the way the
con laws work? The existing hospitals have a vote and whether.
Speaker 4 (27:49):
You can open a.
Speaker 5 (27:50):
New hospital, or like giving McDonald's a vote on whether
Burger King can open a restaurant right across the street.
Speaker 4 (27:58):
It just doesn't make any sense. But that's the way
I would.
Speaker 5 (28:01):
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 something that has to have some work done. But
(28:22):
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
(28:43):
for people, so every year, you know, there's just a
little bit more that's put in.
Speaker 4 (28:47):
Pretty soon everybody.
Speaker 5 (28:48):
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. 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
(29:10):
pay for annual mammograms, right, but you're not getting mamograms
because 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
(29:32):
right now. It's one of the areas, right they have
to spend them limited amounts of money on people.
Speaker 4 (29:36):
I would let people let design their own insurance.
Speaker 5 (29:39):
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 huge improvement because I don't
know anybody who is happy with the exis healthcare system.
(30:01):
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 healthy every year. You know,
(30:24):
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 so poor that they can't
even afford the basics, and just be satisfied with that.
(30:46):
I said, it's not going to be perfect, but it'd
be hard to improve on all right.
Speaker 2 (30:50):
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 3 (31:00):
Our criminal justice system.
Speaker 2 (31:01):
We spend more on imprisoning and prosecuting and chasing down
bad guys in any other country in the world. And yes,
I think we do a far worse job, at less
effective job than most countries in the world.
Speaker 3 (31:14):
And I think meant much of that.
Speaker 2 (31:17):
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. I mean, there
are a number of different applications for where this process
has gone wrong, and it is frustrating. I very much
(31:39):
appreciate your time, professor. I feel the better for it.
The book is overcharged, why Americans pay too much for healthcare?
Professor Charles Silver of the University of Texas School of Law,
Thank you.
Speaker 4 (31:55):
Sir, Thank you, Michael pleasure.
Speaker 2 (31:58):
And with that, might I just 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 3 (32:11):
You know, it's a battle royale.
Speaker 2 (32:13):
And you 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
(32:37):
to your life, 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, it's inefficient. If you've stood
(33:03):
in line at 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 they're coming back and adding these
(33:23):
regulations that.
Speaker 3 (33:24):
Are going to cost this much more for you.
Speaker 2 (33:25):
To build this, and now you're going to walk away
from the project and leave 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 is literal, not to exaggerate,
(33:47):
to save our country.
Speaker 3 (33:50):
ELS has.
Speaker 5 (33:51):
Good men, thank you, and good night.
It's that time time time, time, Luck and load. The
Michael Verie Show is on the air. Professor Charles Silver
(00:23):
is our guest.
Speaker 2 (00:23):
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 same. 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
(00:45):
Great Society, which turned.
Speaker 3 (00:46):
Out not to be.
Speaker 2 (00:47):
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 involve So my dad's
eighty four, my mom recently passed, and I go in
and review every expense, everything that.
Speaker 3 (01:06):
Comes in and all that this whole Medicare thing.
Speaker 2 (01:09):
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 to people that, all
(01:30):
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. 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 4 (01:50):
Too well?
Speaker 5 (01:51):
I just I recently hit that age myself, so I
can sympathize with those whose mailbox are crammed with Medicare
advantage flowers 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 too comprehensive. You know,
(02:16):
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 succeed by massively inflating the deficit.
(02:38):
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
that they get out for most people.
Speaker 4 (02:58):
Now, there are obviously exceptions to.
Speaker 5 (02:59):
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
those benefits has to come from somewhere, and it only
(03:21):
only two sources.
Speaker 4 (03:21):
One is general.
Speaker 5 (03:22):
Tax revenue, so they use money in addition tax revenue
in addition to the employee tax to fund the program.
Speaker 4 (03:30):
And the other is deficit spending.
Speaker 5 (03:33):
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 he created Medicare part D,
the Prescription Drug Benefit Program. Well, the premiums even initially
for that program, we're only set at fifty.
Speaker 4 (03:53):
Percent of the estimated cost.
Speaker 5 (03:55):
Now they're down to twenty five percent of the estimated cost,
which means everybody but he loves Medicare party because it's
a great deal, right, I'm only 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.
Speaker 4 (04:13):
And the same thing.
Speaker 5 (04:13):
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 the long run has to be deficit increases and
inflation increases.
Speaker 4 (04:33):
There's just no getting around that.
Speaker 2 (04:35):
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
(04:57):
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,
(05:20):
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
(05:42):
totalitarian authoritarian control of the individual.
Speaker 5 (05:47):
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
(06:13):
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
(06:37):
why market forces are so important, because market forces are
constantly rewarding providers for figuring out how to serve patients better.
Speaker 4 (06:48):
Right, that's how you can get business. If you can.
Speaker 5 (06:50):
Figure out how to serve your customers better, then you'll
get more customers. And that's just something that requires people
who know that nuts and bolts really well to be
constantly reflecting on how they're doing their jobs.
Speaker 4 (07:05):
Right.
Speaker 5 (07:06):
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
(07:29):
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 you get a build for ten thousand dollars
because you literally because you walked in the front doors.
Speaker 4 (07:45):
It's just like a.
Speaker 5 (07:47):
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 regularly the way healthcare is delivered, and it does
it in stupid ways because it's hard to do it right.
Speaker 2 (08:08):
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 4 (08:20):
And the Michael Berry Show good not.
Speaker 2 (08:27):
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
(08:47):
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,
(09:10):
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
(09:32):
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
(09:53):
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 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.
Speaker 3 (10:13):
Where is that going wrong today?
Speaker 2 (10:15):
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. 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.
Speaker 5 (10:34):
Fan of taxing people who are relatively young to provide
benefits to people who are relatively old. That stricks me.
Is wrong on a variety of levels, you know. One
is every moral theory that I know of says you
move money from richer people to poorer people. Well, older
(10:55):
people are wealthier than younger people. That shouldn't be surprising
to anybody. They've had their lives to work right and saved.
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,
raising families, you know, just getting jobs, dealing with college
(11:15):
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,
excuse me, the system really deserves people because it eliminates
(11:42):
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.
Speaker 4 (11:50):
Well, if people.
Speaker 5 (11:52):
Had to spend their own money, nobody would spend 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,
(12:15):
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.
Speaker 4 (12:28):
We get no bang for the buck.
Speaker 5 (12:30):
You know, we have 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.
Speaker 4 (12:42):
And it's not even a good month.
Speaker 5 (12:44):
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.
Speaker 6 (12:55):
These things just make no sense.
Speaker 5 (12:56):
Right. But the government, the government cannot make the those decisions. Literally,
it cannot because the moment the government starts talking about
rationing care, everybody loses their minds.
Speaker 4 (13:09):
And you don't want to be.
Speaker 5 (13:10):
The politician that they're rallying against. Right, So the government
simply ignores the need to make these decisions and just
spends endless amounts of money because it's other people's money.
Speaker 6 (13:24):
So why does the government care?
Speaker 4 (13:25):
Right?
Speaker 5 (13:28):
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 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 (13:48):
Decisions that each of us makes.
Speaker 5 (13:50):
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 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.
Speaker 6 (14:06):
Some point we will all die, it affects.
Speaker 5 (14:10):
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 needs to be made,
(14:30):
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.
Speaker 4 (14:39):
There's no way the government's going to make a good decision.
Speaker 5 (14:41):
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.
Speaker 6 (14:51):
So, you know, we just have.
Speaker 5 (14:52):
To get the government out of this business. What I
have proposed is.
Speaker 4 (14:59):
That we can.
Speaker 5 (14:59):
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, We're not going to be
having sick people dying in the streets because they can't
(15:22):
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.
Speaker 4 (15:32):
You provide everybody with.
Speaker 5 (15:34):
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 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 4 (15:51):
It just people make.
Speaker 5 (15:52):
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 6 (16:01):
Well.
Speaker 2 (16:01):
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
(16:24):
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 Silverman.
Speaker 4 (16:35):
But everybody knows who this guy is.
Speaker 3 (16:37):
Come on man with the Michael Berry, come on.
Speaker 2 (16:42):
Law professor at the University of Texas at Austin School
of Law. And we ended the last segment with a
discussion that at the end of the day, 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 got one chicken. Mom says,
(17:07):
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
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
(17:28):
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.
Speaker 3 (17:37):
Well, I don't earn as much.
Speaker 2 (17:40):
I want to use the power of the gun through
at the direction of the government, that I either more
of me than there are of the rich people I
vote for. I want them well. The only alternative is
for the government to do it. Professor I Harken back
to a study, and it's been a while since I
read this book. It's interesting because I am a I'm
(18:00):
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 good money after bad.
Speaker 3 (18:20):
So socialist system the opposite of what I propose.
Speaker 2 (18:23):
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, and they chose
not to treat the prostate cancer, and they did about
(18:47):
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 us to treat prostate
(19:07):
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 of money on studies because
(19:30):
and this gets to the second point of what you've
written a lot about medical malpractice and the fear of
medical malpractice.
Speaker 3 (19:36):
I don't think everybody.
Speaker 2 (19:37):
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
(19:57):
I would consider smart, if active 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 a big portion
of what we spend.
Speaker 5 (20:12):
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,
(20:36):
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 medice and at all.
(21:01):
There 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
(21:23):
when 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
(21:43):
help people.
Speaker 3 (21:44):
Right at least that's what it should be.
Speaker 4 (21:47):
You know.
Speaker 2 (21:47):
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 exactly. Self interest drives so many things. That
(22:11):
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 where you and
(22:32):
I can agree.
Speaker 5 (22:34):
I think we do agree on that, but we also
agree that I mean, these social programs have fundamentally undermined
the incentive.
Speaker 4 (22:45):
To save and to be self reliant.
Speaker 5 (22:50):
You know, the I think you know, I constantly 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 4 (23:07):
Right?
Speaker 5 (23:07):
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.
(23:29):
Who wants to save? Saving is born right? Consuming today
is fun. So, you know, I think that as long
as we have these pay go 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
(23:51):
that's a terrible thing, I think, because as you said,
you know, we're 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.
Speaker 4 (24:07):
That just drives costs through the roof.
Speaker 5 (24:09):
Without really any offsetting benefits that make sense of it.
Speaker 7 (24:12):
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 3 (24:24):
You make them slaves.
Speaker 2 (24:26):
They lose the very abilities, and we've seen with evolutionary
studies that teeth are not as sharpenny 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.
Speaker 3 (24:43):
And I think that has to be understood by people.
Speaker 2 (24:47):
Our guest is Professor Charles Silver, who will be with
us for one more segment. The book is overcharged, Why
Americans pay too much?
Speaker 4 (24:56):
Else, that's either risk me or take me to take
talk about it. He gets out of this state, I think,
Michael Barry robs I like it.
Speaker 2 (25:08):
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,
(25:32):
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. My
primary interest is creating a structure where the individual can thrive,
where there is opportunity and fairness, safeguard's rule of law,
(25:55):
and that will, at the end of the day, advance
humanity 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,
(26:19):
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 Galt 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
(26:40):
too much for healthcare?
Speaker 3 (26:42):
Professor Silver, I want you to be king for a day.
You have no.
Speaker 2 (26:47):
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 3 (27:03):
What does that look like?
Speaker 5 (27:06):
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.
Speaker 4 (27:24):
You know, have you ever heard of a certificate of
need law? I don't know.
Speaker 5 (27:28):
They're called con laws 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. Oh okay, I guess what the way the
con laws work? The existing hospitals have a vote and whether.
Speaker 4 (27:49):
You can open a.
Speaker 5 (27:50):
New hospital, or like giving McDonald's a vote on whether
Burger King can open a restaurant right across the street.
Speaker 4 (27:58):
It just doesn't make any sense. But that's the way
I would.
Speaker 5 (28:01):
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 something that has to have some work done. But
(28:22):
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
(28:43):
for people, so every year, you know, there's just a
little bit more that's put in.
Speaker 4 (28:47):
Pretty soon everybody.
Speaker 5 (28:48):
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. 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
(29:10):
pay for annual mammograms, right, but you're not getting mamograms
because 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
(29:32):
right now. It's one of the areas, right they have
to spend them limited amounts of money on people.
Speaker 4 (29:36):
I would let people let design their own insurance.
Speaker 5 (29:39):
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 huge improvement because I don't
know anybody who is happy with the exis healthcare system.
(30:01):
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 healthy every year. You know,
(30:24):
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 so poor that they can't
even afford the basics, and just be satisfied with that.
(30:46):
I said, it's not going to be perfect, but it'd
be hard to improve on all right.
Speaker 2 (30:50):
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 3 (31:00):
Our criminal justice system.
Speaker 2 (31:01):
We spend more on imprisoning and prosecuting and chasing down
bad guys in any other country in the world. And yes,
I think we do a far worse job, at less
effective job than most countries in the world.
Speaker 3 (31:14):
And I think meant much of that.
Speaker 2 (31:17):
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. I mean, there
are a number of different applications for where this process
has gone wrong, and it is frustrating. I very much
(31:39):
appreciate your time, professor. I feel the better for it.
The book is overcharged, why Americans pay too much for healthcare?
Professor Charles Silver of the University of Texas School of Law,
Thank you.
Speaker 4 (31:55):
Sir, Thank you, Michael pleasure.
Speaker 2 (31:58):
And with that, might I just 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 3 (32:11):
You know, it's a battle royale.
Speaker 2 (32:13):
And you 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
(32:37):
to your life, 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, it's inefficient. If you've stood
(33:03):
in line at 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 they're coming back and adding these
(33:23):
regulations that.
Speaker 3 (33:24):
Are going to cost this much more for you.
Speaker 2 (33:25):
To build this, and now you're going to walk away
from the project and leave 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 is literal, not to exaggerate,
(33:47):
to save our country.
Speaker 3 (33:50):
ELS has.
Speaker 5 (33:51):
Good men, thank you, and good night.
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