Why Healthcare Costs Are So High in America

And then healthcare. Like... Did you see the thing I posted a couple weeks ago about this bill we got from when... Jill was with our middle son in San Diego visiting a friend and he was sick. So she had to take him to an ER, right? Like we don't... Our doctor's not there, right? Obviously we live here. So they did like regular chemistry lab on him. That's like about a $12 blood test and gave him like, I don't know, 250 to 500 cc of IV fluid. That was it. That was it. What do you think the bill was? $1200. I don't remember it because I'd have to look at the post I put up. I think the bill was $6000, of which we owed $2000. That's insane. That's problematic. That's a real problem. Yeah, it might have been more than that. $6000 bill, our insurance somehow picked up maybe $3500. We were stuck with $2500. Now juxtapose that with the following fact. Fewer than 50% of Americans today, if given 24 hours, can produce $2500 in cash. Jesus Christ. So when we say healthcare is the leading cause of personal bankruptcy, it's the first, second, third, fourth, fifth... Like there's nothing else matters besides healthcare when it comes to personal bankruptcy. I mean, this does infuriate me to no end. Like I sometimes think like, is there any other problem I would ever be interested to devoting my full attention to besides the problem I work on now? That's the only other problem that would tempt me. You know what's interesting too, if that problem was really tackled by our government and they did it in an efficient way, one of the ways they would have to do it, one of the ways they would have to address it in order to be efficient would be to encourage people to become metabolically healthy. Of course. We have zero encouragement. Zero. In fact, there's actually the opposite. There's encouragement for people to have body positivity and to not be fat phobic and to not fat shame. And there's zero discussion about healthy diets and vitamin supplementation and the benefits of that. If they just did... Like imagine the government was responsible for our healthcare and they realize, hey guys, guys, guys, we've got a real problem here. We're spending too much money and we're losing money because what if the amount of money that they made was dependent upon the percentage of money that was spent on healthcare? Like imagine if politicians, if their salary depended on the... See, but I fear that that would still get screwed up because then they would just cut costs, right? Like I feel like... What if that wasn't an option though? What if like those standard care? We have to cut costs. This is the problem, right? We're spending... We're probably up to $10,000 per capita, which is... I mean, we're actually probably more than that. We're probably $12,000, $14,000 per capita. So we're at 2 to 5x every other developed nation and what we spend on healthcare. But why? And we get worse outcomes. Okay. So the big reason comes down to made up numbers. Look at my ER example. The blood test cost, the actual cost of ordering that blood test is $12. The bag of IV fluid is probably $38. So why do they inflate the cost so much? It's because they play a shell game with the insurance company. So they say, we negotiate different rates with different insurance companies and we're going to build up the price enormously, but we're going to offer you a really big discount and we're going to make you our preferred network. We're going to be your preferred network and there's a quid pro quo here, which is the price is enormous, but you don't actually have to pay that much. We're going to discount it to you. But if somebody comes in out of network, which we were, right? We were out of network because probably our network is optimized around being in Austin and not in San Diego. You're going to get screwed. And of course, if you don't have insurance, forget about it. You're paying the fake money price. Especially if there's a real injury. Oh yeah. The real injury, you need surgery and you're not insured. Oh my God. The other thing is we don't have the same laws around like drug pricing, right? So, so drug, you know, the, the United States basically subsidizes the rest of the world in drug pricing. So we, in exchange for getting first dibs on the best drugs, we pay a higher price for them. And other countries are basically not going to pay that because you also have better purchasing power. So if you look at Canada, for example, like the government is buying the drugs, not, not that, not that, not the payer, right? So it's a, it's a, it's a totally different system. And the challenge is no system is going to be perfect, but what really bothers me about the discussion is we're missing the point that there are three variables that need to be optimized around. And everybody just talks about their favorite one, but you can't talk about one without talking about the other two, because if you pull on one lever, you got to let up on one of the other levers. So the three levers are cost. How much does it cost to deliver this care? The second is quality. How good is the care? And the third one is access. How many people fall through the cracks? So if you look at the United States, we're very good on quality. When we deliver care, it's the best. There's a reason people come from all over the world here when they need their cancer surgery. Right. We are certainly at or in the, you know, at or above the best for everything that would be done in medicine. On cost, we are absolutely the worst. There's literally no country that pays more than we do for a given service. And on access, we're horrible for a developed nation. Horrible. Right. The number cost, like what is the difference between like, say, United States and Canada? Yeah. Two and a half X, I would bet. Maybe three X. Wow. That's so crazy. And that's not like a third world countries. I'm like, that's it. So Canada is killing us in cost. They're killing us in access because everybody's covered. But we have better quality. So you have to, so that's, that's the trade off. Like, right. I mean, I do talk about how my mom is getting largely veterinary medicine in Canada. I mean, like, her healthcare is horrible as far as I'm concerned. Yeah. Totally unacceptable. Many friends in Canada that have complained a lot. No, no, it's totally unacceptable. So they have bad care, but it's more accessible. But at least everybody gets it and it doesn't cost you any money. And it's, is it bad care because the physicians are not incentivized to provide better care because they don't make as much money? No, no, no, no. So first of all, I mean, at least I don't know if I don't want to speak out of school because I'm so far removed from it. But when I was growing up, they had introduced salary caps. So physicians salaries were capped. So when you hit your cap, you retie, you stopped working for the year. So high earning surgeons like would retire, not retire, would stop working in August because they'd hit their cell. Like, let's say the salary cap was $300,000. If you earn $300,000 by August, you weren't going to get paid anymore. So though they would just sit down and sit out the rest of the year and then January, it would create this real problem where there was a bottleneck shortage of docs. Yeah. Yeah. But the bigger issue is just that the government is in charge of what gets done and what does not get done. And there's sort of shortages, right? So if you like things that you and I take for granted, right? If you tweaked your knee at jujitsu tonight, you go get an MRI tomorrow. That doesn't happen in Canada. In fact, in certain provinces, it's illegal to have private clinics where you can go pay out of your own pocket to get an MRI expedited. God, it's illegal? Illegal. I think Ontario is one of those provinces by the way. Really? Yep. So Toronto. In Toronto, I do not believe it is legal to have private medical clinics where you can pay out of pocket. So this is where when people say, oh, we should just be like Canada, I'm like, no, we should do something Canada does. We should have universal coverage. And then have the option. And then you have the option to bolt on. Yeah. But would that be sort of like public defenders versus a really good attorney? No, I don't think it would be. No, I don't think it would be. Yes, of course. No, I think one of the things you have to do is provide primary care and emergency services for free. Because that's where 90% of your care would be delivered. And is the problem that because of these made up numbers that you discussed earlier, that these people in this country at least are accustomed to charging these exorbitant fees, like $6,000 for a bag of IV? Oh, yeah. I mean, I had my I got a colonoscopy every three years. So I had my last one last this time a year ago. And, you know, because it's funny, that one should have been covered. I don't remember the details on it. But because I was over 45 at that point, so it's counted as a screening colonoscopy. But I've historically always had to pay cash for my colonoscopies because I started doing them when I was 40. And the cash cost of getting a colonoscopy at like one of the best guys in New York City who I've always gone to is $2,000. That's the fully loaded cash cost. That means that's covering the facility fee, the anesthesia, his fee, etc. The one I got here in Austin, where I did it through insurance, the fee was $6,000. I got the bill. And you know, my insurance picked up. Maybe this is the one I'm anyway, my point is my cash out of pocket was almost as bad as the cash I paid for just a full up cash one. It had a whole bunch of made up numbers. I actually called my gastroenterologist, the guy who did it. And I was like, you got to walk me through this because like, I'm struggling to understand these costs. And he couldn't really explain it. He's like, I mean, I don't know. Like, I don't really understand it. He's like, but you know, like everybody has sort of a different amount. You know, it's like being at like a bazaar where it's like, oh, I have special price for you today.