David Pakman Explains the Problem with Medicare for All | Joe Rogan

Beyond anti-speech or want to limit speech or whatever. That's a pretty big issue though. Well I don't actually agree that it exists on a significant portion of the left. Like I think a bigger issue for example, like if you said what is like a serious issue that the left needs to contend with right now? I would say a more serious issue is if you look at the progressive accomplishments of the early 20th century for example, like 1905 to 1925 and the New Deal accomplishments that the left had in the time of FDR. What was different I think then than the left now is that you didn't have to be completely in line with a specific set of policies or ideas. And I worry that now there's a little bit of the left maybe having this idea that if you're not in line on all of these issues, whatever the checklist is so to speak, you're not really worthy of being a participant in what is clearly a leftward move in sort of the average American's political orientation. I don't want to see that prevent progress. Yeah, that's the hard tribalism, right? That's where the line gets drawn, you're with us or against us. There's one way to think. There is a lot of that. I mean I saw it with healthcare recently. With healthcare, I don't think that you can make any serious case from the left that healthcare is fine and the for-profit employer connected system that we have is working. I don't think there's any progressive case to be made for that. Where people will differ is what about Medicare for all versus some other system, system that looks more like Canada's or the UK or Germany or whatever. And I've already started to see, when I say on my show, I'm kind of agnostic on this. The system we have is a disaster. We need a system that will get coverage to everybody. The numbers can be made to work any number of different ways. We've looked at it, but 80% of people on Medicare, I believe it is, have some additional coverage. They either are still working part-time or full-time and get coverage that way or they're poor enough to be on Medicaid. The point is Medicare for all doesn't solve every issue. It's way better than what we have. But here's like a dozen other possibilities looking at other countries. There is a portion of the left that doesn't like that because I'm saying I'm against Medicare for all. I'm not saying that. What I'm saying is there are a number of different ways to improve upon the system we have, all of which sever this relationship between usually your employer and these for-profit insurance companies. Why can't we be open to that? I really don't understand private citizens that don't want easy access to quality healthcare for everybody. That confuses the shit out of me. Have you ever been hurt? Have you ever been sick? Have you ever been broke? Do you want to be broke and have no access to healthcare? No one does. No one wants anybody they care about to not have access to healthcare. Of all the things that we concentrate on in this country, there's two things that drive me fucking crazy that people just dismiss, education and healthcare. The idea that you have to, like my buddy Greg, Greg Fitzsimmons, he sent in his kid off to school. How much did he say that it was? 65, I think. $5,000 a year for both of his kids, for each of his kids. So he's got two kids. That hurts my head to even think about spending $130,000 a year just on ... If you're a regular person with a regular job, how the fuck do you do that? Impossible. It's impossible. It's so much fucking money. And then that's not even paying for housing and food and transportation and books and everything else that you're going to need too. To make it more difficult for young people to succeed is one of the worst ways to make a stronger country. If you want a strong country, you want educated people that get to pursue their dreams. The idea that we are so willing to spend so much money on these costly regime change wars and flying troops overseas to these places that they don't want to go, no one wants it to happen. It's trillions of dollars and people are fine with that. But you talk to them about some sort of socialized education system and people freak out and think you want to turn us into communists. Well, I think what is really important to understand is that the facts you just laid out don't matter to people who see this as an issue of what do people deserve. What do they deserve? So if you say to a fiscal conservative, if you consider the amount that the employee pays for premiums plus the employer plus your co-pays plus co-insurance, you put it all together into some amount and you explain to them there's lots of great analyses that have been done which tell us that with roughly the same amount of money, maybe a small payroll tax in addition with roughly that same amount, it all could be done with a single payer system that covers everybody. It's the same. You're taking all of these individual risk pools where you have different for-profit insurers and then you have systems for people that don't have enough money, Medicaid. You have systems for people that are over 65 Medicare. You put it all together, you spread the risk far wider, the employer no longer has to pay their part of the premium, the employee no longer pays part of their premium to the for-profit insurance company. The numbers work. They're still not going to say, you know what? That sounds great. It's actually pretty fiscally conservative. Let's do it because at some point there is a portion of the right that just doesn't think people have earned healthcare. They just haven't earned it. Or education. Or education. That's right. It's hard to change people's minds when that's their view. I think it might be George Lakoff who I believe calls it strict father morality, which is like how would a really strict father treat a child who comes to them and says, hey, you know what? I figured out a way that we can all have healthcare. The strict father, even if the numbers make sense, would say, I'm going to teach you a lesson. You haven't earned that healthcare either because you don't work or you don't make enough money or you're on disability, whatever the case may be. How do you convince someone to change their mind when that's their worldview? Yeah, how do you? When it's an ideologically based decision and you're on team R or team L, which group of ideas do you adopt? The UK system sucks. You talk to people that get healthcare over in the UK, it sucks. But at least they have a system. It's just not the same quality healthcare that you get in America. Same with my friends in Canada. I have friends in Canada that have come down here to get surgery because they find better doctors over here because they've been sent to all this. Brent Hall was going to Canada to get his operation. Yeah, that was, why was that? Why did he do that? The best places in Canada. The best place for hernias? For that type of hernia, I believe. I mean, here's the thing, even in saying the UK system and the Canadian system, neither one is that good. Those two systems are totally different. So I feel like- But they're both socialized medicine. They are both, well, yes, in some sense. The Canadian system is administered at the province level. So the province is sort of like the market. Instead of having all these sub markets attached to individual for profit insurers at the provincial level, that's how it's organized. The UK has the National Health Service where they're actually, they don't actually run the healthcare facilities, but they are the ones who are contracting them. So it's sort of like the healthcare facility still is its own entity. It's not that you're going and the government is the employer of the doctor, so to speak, but they're contracting with the healthcare facilities. But the point I want to make is that there are criticisms of all of these systems, but they're different ones. So when we say the British and Canadian systems aren't that good, let's figure out in what ways each is not that good because they're different ways, whether you're talking about health outcomes, early detection, cost per treatment, whatever. You really have to drill down and figure out in what way are we saying it's not as good. Yeah. What I'm saying is that there's no perfect system. There is no perfect system. Those systems aren't right, but I believe that most of the best doctors in terms of like North America at least are in the United States. I'm sure there's probably some very good doctors in Canada that do specialized medicine, but I think really good doctors are incentivized by profit. I really do. I think there is some motivation for if you spend so much money for medical school and you bust your ass, you want to make a lot of money and some of the best doctors earn a really good living. That may be. I think limiting their ability to earn that money won't incentivize people to be excellent. So a couple of different things. I mean, number one, to be clear, we're now starting to get into a little bit of broader economic philosophy. Like I'm a capitalist, I'm for social democracy, which is a mixed system. It's a capitalist system that says we're going to invest tax revenue in a particular way to make sure that no one falls below a certain level. So my just to contextualize that my point of view is not from one of becoming a socialist country. I think we share those views. I think so. A lot of doctors will say that even though on sort of on paper in a socialized medicine system, they might make less for a particular procedure, for example, or something like that. A lot of them are still in favor of those systems because it would drastically reduce their overhead. So there's all of this apparatus that includes medical billing and coding both on the insurer end and at the health care provider end, the hospital and the insurance company both are battling over what is it that was done? What are the codes that apply here? And how what are our reimbursement rates? There's fraud when it comes to that. And that requires an apparatus for investigating and adjudicating that that adds more and more cost. So I don't think it's as easy. I don't think it's as obvious that under those systems at the end of the day, a doctor that owns a PCP group, for example, or an orthopedic clinic or whatever the case may be, I don't know that it's that clear that they end up taking home less money. Hmm. That's interesting. I'd wonder if in practice that would play out that way. Maybe I'm talking about just like high end orthopedic surgeons that do knee surgeries for athletes and things along those lines. They often would be outside of whatever insurance apparatus we're talking about. Anyway, a lot of those folks are often being paid out of pocket anyway. Yes. So it's less in the least some at least some. So for the average person's experience, I think it's less relevant. Then there's also liability insurance, which is extremely expensive. That's a giant issue with doctors. It's a huge expense. It is. Yeah. I mean, I think it is necessary. There's a question as to whether it's organized in the best way. I know less about that component than some of the other ones.