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October 9, 2025 15 mins
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Speaker 1 (00:00):
I am pleased to have with us again the president
of the Paragon Health Institute, a nerdy think tank that
talks about making healthcare better. Boring, but boy, am I
glad they're doing it. So Brian Blaze, welcome back to
the show.

Speaker 2 (00:12):
First of all, thanks me.

Speaker 3 (00:15):
I'd be great to be with you.

Speaker 1 (00:16):
So let's talk about a tweet or post or whatever
it's called now that you sent out yesterday, because there's
a whole bunch of stuff happening right now around Obamacare,
and I would argue that the promises of Obamacare are
coming to fruition right now. And one of the reasons
that the Democrats are arguing so hard to keep everybody

(00:38):
on Obamacare subsidies, even though they weren't originally intended for them,
is that they require more and more people on the
dole to get to the end result, which I think
is they've always wanted single payer, and this is just
a middle step to single payer in my view.

Speaker 2 (00:50):
You don't have to comment on that if you want.

Speaker 1 (00:52):
To, But the reality is is that they've been shifting
more and more responsibility for these plans onto the taxpayer
for years. And how did we not know about this
until now?

Speaker 3 (01:04):
Brian so Obamacare significantly increased premiums in the individual market.
The court changes in Obamacare took effect in twenty fourteen,
and on average, there was a forty seven percent premium
increase from twenty thirteen to twenty fourteen. The only way

(01:28):
that people buy these plans is if they either expect
to have significant medical expenses or they receive large subsidies.
The key with understanding the subsidies there's two keys. One
they go directly to health insurance companies, so the person
picks a plan the plans offered by an insurer, they

(01:50):
qualify for a subsidy. The Treasury sends the insurer a
check every month that that individual is enrolled. The second
key point with the subsidies is that they limit the
amount that an enrolle has to pay, So his premiums
have gone up over time, the taxpayer has picked up

(02:11):
the entire cost of the increase, So in twenty fourteen,
the average taxpayer share was about thirty three percent. It
was about sixty seven percent in twenty twenty, it was
eighty percent. In twenty twenty one, during COVID as a
temporary pandemic measure, President Biden signed legislation that shifted even

(02:36):
more of the cost from the enrolle to the taxpayer.
So for the typical enrolling now ninety three percent of
the premium is paid by the taxpayer. They set those
subsidy add ons to expire after twenty twenty five, so
for the typical enrollly they'd go back from ninety three

(02:59):
percent of the our ninety three percent of the premium
paid by the taxpayer to about eighty percent of the
premium paid by the tax payer.

Speaker 1 (03:08):
I mean, Brian, this is so frustrating. Not only did
they do that, they also significantly raise the income limits
for subsidies, so they added an entire new class of
people onto government subsidies. And I've been really frustrated because
our own Senator John higgen Looper is tweeting out that
this healthcare crisis is created by Republicans. Not a single

(03:28):
Republican voted for any of this, not a single one
on any of these bills. So how exactly did we
get to the point where we are now, where we're
paying so much? Was that all part of ARPA or
the Inflation Reduction Act or was there separate legislation that
did that?

Speaker 3 (03:47):
And you're right. The subsidies originally were capped for people
making below four times the poverty line, and what ARPA did,
which was the first Biden stimulus, was increased the sub
cities to insurers for twenty twenty one and twenty twenty two.
In the summer of twenty twenty two, they extended these
COVID era subsidy add ons through twenty twenty five. And Mandie,

(04:12):
You're absolutely right. Not a single Republican voted for Obamacare.
Not a single Republican voted for these expanded subsidies. So
it is I mean, the Democrats are blaming Republicans even
though not a single Republican has ever supported the Obamacare structure.

Speaker 2 (04:29):
Is there?

Speaker 1 (04:30):
And I don't mean politically, what if any is there
any plan? Are you aware of any plan? Does Paragon
promote any plan that would potentially do something to go
after the underlying causes of health insurance? Because I read
the Obamacare bill when they passed it. I read every
stupid iteration of that bill back in two thousand and eight,
and I told my listeners then it was never designed

(04:52):
to control costs in any way. There's nothing in Obamacare
that is really going to control the rise of healthcare costs.

Speaker 2 (05:00):
What could we do to go after.

Speaker 1 (05:02):
The root cause of why health insurance is so expensive,
and that is healthcare is so expensive.

Speaker 3 (05:10):
Yeah, So I'd say there's a couple of things. One,
healthcare is expensive, and healthcare has been made more expensive
by bad government policy. So partly it's because government is
over subsidizing demand and creating all of these mandates on
what insurance has to cover. And the more the insurance covers,

(05:32):
the less the enrolle. The consumer is sensitive to the
price of the services, so the more pricing power goes
to providers. So actually you just by increasing mandates on
what insurance has to cover, you will increase the price
of healthcare. Government also does other things, like through the
way that Medicare program sets payment rates. Medicare pays much

(05:56):
more for the same service if it's delivered in a
hot hospital then if it's delivered in a physician office.
And one of the things that happens in commercial insurance
is that they often bench their crisis to how Medicare pays.
So because Medicare pays inflated prices, we play it pay
inflated prices commercially. One other thing about Obamacare Obamacare's subsidy

(06:19):
structure is inherently inflationary. If the enrollee is held harmless
from any of the premium increase, and all of the
premium increase over time is borne by the taxpayer. Insurers
know that they know that they're able to raise premiums
and pass the cost off to the federal taxpayer. What

(06:41):
that means is that they can go into negotiations with
providers and say, yeah, we can pay you providers more
because our enrollees aren't going to bear any of the
burden of these higher premiums. So Obamacare, by linking this
a little wonky, but by linking the subsidy to the premium,

(07:03):
is independently inflationary on health care prices. So fundamentally, we
need to reduce all of these distortionary subsidies of health
care that pass the bill to everybody else but ultimately
we all pay, and then also reduce these government distortions
that have so inflated really hospital.

Speaker 2 (07:21):
Prices, I was explaining to the audience earlier.

Speaker 1 (07:24):
Normally, in a capitalist transaction, for lack of a better
way to put it, you have someone who is going
to put downward pressure on pricing, right, But in a
third party payer system that we have with insurance, We've
created a triangle and nobody has an incentive to drive
costs lower. That's the distortion that you're talking about. And

(07:44):
so now we've got a third party subsidy on health
insurance that is distorting a third party distorted healthcare system
in the first place. So we've gone so far away
from anything that could be considered a capitalist type system.
What would some of and I'm sure you guys have
talked about this, what are some of the ways you
see to inject free market wherever we can into healthcare?

(08:07):
Because I've long had an idea, and I don't know
if it was original to me, but we should have
two kinds of healthcare.

Speaker 2 (08:12):
We should have scheduled.

Speaker 1 (08:13):
Health care, we should have emergency healthcare, and they should
have different kinds of coverage if I need a hit replacement.

Speaker 2 (08:19):
There should be able a way.

Speaker 1 (08:20):
To inject market forces into that, don't you think.

Speaker 3 (08:25):
Yeah, So you have to look, there's two sides of
the market. There's the consumers in the demand side of
the market, and then you've got the producers in the
supply side of the market. And government is screwed up
both sides of the market. On the supply side of
the market, we need medical professionals to be able to
practice to the top of their license, for nurse practitioners
to be able to take care of patients to their ability.

(08:47):
You know, Obamacare contained a provision that makes it much
more difficult for physician to owned hospitals. That really gives
an advantage to traditional hospitals, even though we know that
physician owned hospitals tend to have lower costs and better
quality outcomes. So we need to and a lot of
states have these things called Certificate of needed requirements, which

(09:08):
means you can't expand supply, whether that's new hospitals or
imaging equipment, unless you get permission from the existing market
entities to have competition come on. So we've restricted competition.
On the demand side. We have you know, as you

(09:29):
correctly note all of this subsidy for third party payment.
What we need to do is restore the financial control
to the individual patient. So we have thought through and
have some specifics on government's going to subsidize healthcare. It's
going to subsidize healthcare for the elderly, it's going to
subsidize healthcare for lower income people. How about taking those

(09:50):
subsidies and sending them directly to the patient has HSA contributions,
so the patient has maximum flexibility to choose the care
that works best for them, rather than just funneling everything
into the current system.

Speaker 2 (10:03):
I completely agree with that.

Speaker 1 (10:05):
I actually just thought of a question based on a
comment you made a little earlier in this interview, and
that is you just said Medicare reimbursements are higher for
hospital patients than it is outside the hospital. Is that
why hospitals are buying every doctor's office? Are those larger
premium reimbursements happening in a doctor's office that is now

(10:25):
owned by a healthcare system?

Speaker 3 (10:28):
That's exactly why hospitals and physicians. They have mutually beneficial
financial interests for the hospital to buy up the physician practice.
So you can have an independent physician practice one day
that is bought up by the hospital, and the next
day crisis will double, even though nothing has changed about

(10:52):
that office other than the fact that it's gone for
being owned by an independent set of physicians to the
hospital into physician office.

Speaker 1 (11:01):
So essentially the game was set by the government deciding
that those reimbursements are going to be higher, and you've
got independent offices that have to maintain billing and insurance
and all of that stuff, and they come in and say,
we're going to take care of all that.

Speaker 2 (11:14):
We're just going to buy you out. I mean, it's
really a genius system.

Speaker 1 (11:17):
And I don't hate them for taking advantage for the
way that the game is rigged, but it does seem
to be that the game is significantly rigged to favor
large healthcare providers that are now making more money from Medicare,
which means Medicare what is insolvent faster now.

Speaker 2 (11:33):
I mean, and don't get me wrong, Medicare.

Speaker 1 (11:35):
Reimbursements for a lot of stuff suck really bad, right,
I mean, they just do. But that just seems like
to see how clearly the game is set up is interesting.

Speaker 2 (11:44):
To me now.

Speaker 3 (11:47):
I mean, the government has created distortions of an unbelievable
magnitude in the healthcare sector. I mean, for your listeners
that have taken like the basic economics class, you know,
first learn supply and demand, and then you learn about
price controls. And whenever you have price controls, you reduce
the market's signal for what value is placed on things,

(12:10):
and you get access or you get an under provision.
And think about the health sector. We are set by
price controls. The price has come out from a bureaucracy
in Washington. They come out through the Medicare program. And
because part of it is just how lazy commercial insurers are.

(12:31):
And this is a sort of a new pairingon We've
commissioned some research on this. They just benchmark to Medicare payments.
So if you want to you know in so you
have all these prices that are set by the deureaucracy.
They also determine whether new services or new you know, pharmaceuticals,

(12:53):
whether they can come into the market, and what price
point they're set at. So there's so much We allocate
so many of our resources in healthcare by whoever has
the best lobbyists. And that lobbying in healthcare is seven
times more than lobbying for the defense really to the

(13:14):
defense industry.

Speaker 2 (13:15):
Holy cow, I'm not surprised at all by that.

Speaker 1 (13:19):
I mean here, I don't know where you're located, Brian,
but here in Colorado, we just passed a new insurance
mandate that you have to pay for cosmetic surgery for
trans people. I can't get a boob job but if
you Brian Blaze would like a boob job, you can
get one here in Colorado, paid for by your insurance company.

Speaker 2 (13:37):
It's really frustrating to be.

Speaker 1 (13:38):
A talk show host and know all this stuff because
they used to sell health insurance and life insurance. This
sold all that stuff, So I understand it. How many
people truly don't understand how all of these mandates are
driving up the cost of insurance dramatically for everyone. That
would be a message that I think would be nice
if we could get that out.

Speaker 3 (14:00):
You know, I agree. I mean these mandates, you know,
the special interests come in, and so the cosmetic surgeons
come in and they want the additional mandates because that
makes people less sensitive to the price changes. And you know,
insurance is supposed to be the pulling of resources to

(14:22):
finance unexpected, unpredictable events. So that's how most insurance works,
like life insurance, home insurance, auto insurance. That is not
how health insurance works. So there's a portion of health
insurance that is sort of that financing of unpredictable risk.
But a lot of health insurance is just prepayment of

(14:44):
medical care, and it drives up demand because people pay
this amount in advance, and they're like, well, we've got
to get our you know, to get benefit from all
of this money that we've paid in our health insurance prevos.

Speaker 1 (15:01):
It's a perverse cycle and that's where we are. Brian
Blaize with the Paragon Health Institute, thank you for coming
on the show. Thanks for what you guys do being
as nerdy as you are. Keep it up on X
because I follow you on X and you give me
great information quite often.

Speaker 2 (15:16):
So keep up the good work. Brian. Thank you. We'll
do

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