How Health Care in the United States Works Right Now


Announcer

Welcome to Stuff You Should Know from howstuffworks.com.

Josh Clark

Hey and welcome to the podcast. I'm Josh Clark. With me as always is Mr. Charles W. Chuck Bryant. How are you doing, Chuck?

Chuck Bryant

Well said.

Josh Clark

Good. Well, that's a good word.

Chuck Bryant

It is for this show.

Josh Clark

This is Stuff You Should Know and actually, this is a special edition of Stuff You Should Know.

Chuck Bryant

Indeed.

Josh Clark

Part one of a four-part series.

Chuck Bryant

Yes. Should I break it?

Josh Clark

Yeah.

Chuck Bryant

Healthcare and healthcare reform. Everyone seems to be really confused about what lies ahead in the United States and our healthcare system.

Josh Clark

It's so confusing, Chuck that I'm not even certain if healthcare is spelled as one word or two.

Chuck Bryant

I don't even know.

Josh Clark

That's pretty much the level that we're at in understanding of healthcare, let alone healthcare reform.

Chuck Bryant

Right. So we're trying to figure this out along with you guys. Maybe you can learn something here.

Josh Clark

Yeah. So I guess let's kick it off. Let's get this ball rolling.

Chuck Bryant

Yeah. We're not gonna talk about future plans. We're gonna talk about how it is today.

Josh Clark

Yeah, well, in this podcast.

Chuck Bryant

Right.

Josh Clark

In this edition.

Chuck Bryant

In this edition.

Josh Clark

Part one of four.

Chuck Bryant

Part one of four.

Josh Clark

Yeah, it's about the current healthcare system in the United States and Chuck, have you ever gone without health insurance?

Chuck Bryant

Oh yeah.

Josh Clark

Yeah, how long?

Chuck Bryant

Oh man, I seem to think that after my parents ceased - I think this is a familiar story for everyone; some time around after college until I got my first real job which was at least seven or eight years later.

Josh Clark

Yeah, I think I did a decade; same story.

Chuck Bryant

And the parents are always on you like, "Oh, you know if you had an accident." And I was like -

Josh Clark

Yeah, exactly.

Chuck Bryant

And luckily, it worked out; no accidents.

Josh Clark

Same here. I don't think it works out quite so well for everybody, but yeah.

Chuck Bryant

Sadly.

Josh Clark

You and I are - lead charmed lives. Well, I guess we'll get to the uninsured soon enough. So Chuck, let's go back to the beginning: 1920s in Texas. A guy named Justin Kimble founded a company named Blue Cross. It's still around today, as I understand it.

Chuck Bryant

We understand because they have a floor right below us, I believe.

Josh Clark

That's right. That's where I've heard that name before.

Chuck Bryant

Yeah, we share a building.

Josh Clark

So he started an insurance program plan where woman contributed - I think teachers specifically, contributed $.50 out of every paycheck toward their eventual maternity needs. So when they went to the hospital to have a baby, they were already prepaid. It's not really insurance, but a prepaid plan.

Chuck Bryant

Right, great idea at the time.

Josh Clark

But there was something that came out of it that really gave birth to the insurance industry in the US if you'll forgive the metaphor. Not all of these teachers had kids. Bing, bing. So you could actually make money selling policies to people because not everybody's going to get cancer.

Chuck Bryant

Right. And that's how the whole system still works today.

Josh Clark

It's a gamble. Ned Flanders once said on The Simpsons - actually, it wasn't Ned. Maude Flanders was explaining Ned's position that they don't have any kind of insurance because Ned considers it a form of gambling. And it really is. On one side, you, the insured, are betting that at some point in time, some injury or illness is gonna befall you that's going to cost more to treat than you've put in, in monthly payments towards your policy.

Chuck Bryant

Right, I love it. It is total gambling.

Josh Clark

The insurance company, on the other hand, is betting that you will be hit by a bus and die immediately or something along those lines where you're not going to need any kind of care.

Chuck Bryant

Right, or that you just lead a healthy life and nothing happens to you, which is not gonna - clearly, not gonna happen.

Josh Clark

I think the hit by the bus scenario is the absolute best that can happen for an insurance company. But so yeah, it's a form of gambling and you're going head to head with the insurance company. And sometimes it pays off, sometimes it doesn't, but for the most part, it's a pretty good system basically speaking.

Chuck Bryant

Yeah, and you pay for peace of mind a lot of times is what a lot of people say.

Josh Clark

You sound like a shell.

Chuck Bryant

I sound like I'm selling insurance?

Josh Clark

Yeah, exactly.

Chuck Bryant

I believe that was from "Bart and Fink".

Josh Clark

Was it?

Chuck Bryant

Yeah, John Goodman said that he sells piece of mind.

Josh Clark

Nice. Well, Chuck, let's fast forward a little bit. By the 1940s companies had already begun offering employer [inaudible] insurance plans.

Chuck Bryant

Yeah, that was a great incentive to get the best and the brightest.

Josh Clark

Definitely and actually -

Chuck Bryant

It still is.

Josh Clark

- because of this business, which is a sector of US society, obviously, part of the economy which is what I wanted to say, but business is a sector just like population's a sector; government's a sector; that kind of thing. Business said, "We're gonna take the burden of healthcare on our shoulders."

Chuck Bryant

Yeah, sort of.

Josh Clark

In 1943 the IRS supported this and encouraged it with a ruling that said employers can pay for these programs, these plans for their employees out of pretax dollars, which makes the whole thing really attractive. And all of a sudden, the US has what amounts to a state sanctioned employer healthcare system.

Chuck Bryant

Right, which still thrives today.

Josh Clark

Which is good.

Chuck Bryant

Same pretax dollars, same deal with the IRS.

Josh Clark

The chances are good that you - if you have insurance in the US, you have it through an employer.

Chuck Bryant

Yeah, most people have insurance through their company and their employer. Not as many people have the more expensive and harder to get individual insurance.

Josh Clark

Yeah, I think 56 percent get it through their employer and 30 percent get it through the government run program.

Chuck Bryant

Medicaid or Medicare.

Josh Clark

Right, Medicaid and Medicare were created in, I think, 1965 by the Johnson administration, LBJ. And the S Chip is the other big one for children. And that's state run like Medicaid. Medicare is for the elderly and the chronically disabled and peculiarly, people with kidney failure.

Chuck Bryant

Yeah, renal failure.

Josh Clark

Yeah. Medicaid, as I said, it's state run, is for other people with disabilities, the poor and pregnant women. And then S Chip is for kids.

Chuck Bryant

Yes, and that is - covers uninsured children under the age of 19 whose families earn up to $36,200 per year.

Josh Clark

Look at you with the stats.

Chuck Bryant

I've got a lot of stats.

Josh Clark

I was gonna say I sense that that's the first of many.

Chuck Bryant

Right. And then actually, there was one more that I don't know if you knew about: the high risk health insurance pools?

Josh Clark

Yeah.

Chuck Bryant

And these are people that have preexisting conditions that normally, would not be able to get insurance at all and they - what they do, is they group these people together; same concept as an employee based deal.

Josh Clark

Those are the ones you see on little $.99 signs on the side of the road like, "Need insurance?" kind of thing that you just get lumped together. So yeah, there's - you just pointed out one type of insurance which is group insurance. Most employer plans, probably all insurance employer plans are group insurance.

Chuck Bryant

Yeah, and it works because it is a group because you're - and these are good because you usually don't have to fill out the big questionnaire about your eating habits and your smoking habits.

Josh Clark

There's no physical exams.

Chuck Bryant

Exactly.

Josh Clark

And pretty much anybody who wants to take part can contribute and be insured. Any employee I should say and usually their family, kids; that kind of thing. A very small portion of the US population has individual plans and one of the reasons why is because you have to go through a rigorous screening process.

Chuck Bryant

It's not cheap.

Josh Clark

If you are found to have a preexisting condition, you can be denied insurance.

Chuck Bryant

Very easily.

Josh Clark

I imagine pretty heart breaking. And yeah, it's really expensive. It's very - it's an expensive proposition whether you're an employer or an individual and increasingly, an employee. So we'll get to that in a minute. What are some of the types of insurance plans that are out there in the US today? There's pretty much two umbrellas, right as far as models go?

Chuck Bryant

I would say so. I think you're talking about the FFS, the fee for service model and then the managed care model.

Josh Clark

You know these so well.

Chuck Bryant

I know. Which under the managed care is when you hear about HMOs and PPOs and POS and - those are all managed care.

Josh Clark

Yeah, the big - I guess the main characteristic of fee for service is - and this is the original model for insurance -

Chuck Bryant

Yeah, indemnity insurance.Josh Clark: You pay your monthly premium and you're insured. You come down with a cold, you go to the doctor, the doctor cures you.

Chuck Bryant

He gives you a Coke and says, "Drink this and you'll be fine."

Josh Clark

And smoke this cigarette.

Josh Clark

And you pay the doctor, you file some paperwork, your insurance company reimburses you and you go along your merry way continually paying your monthly premiums again.

Chuck Bryant

Right. That's kinda the old school model like what our grandparents probably had.

Josh Clark

Right. And then I think in the '80s the HMOs came about. Managed care became much more popular than the FFS model. And actually, there's some plans that kinda combine the two, but with managed care - with fee for service, the emphasis is on treatment. With managed care, there's more emphasis on prevention supposedly.

Chuck Bryant

And that's where it really - that's one of the big sticking points with this whole mess that we have in this country is a lot of doctors and a lot of managed care still don't practice enough preventative care they say.

Josh Clark

Right. So at the center of the managed care model is a primary physician who is supposed to know you, know your family, know your history, know that you eat more donuts than you should, know that you lied on your insurance form when you said you don't smoke, and is saying, "You're gonna get diabetes, you're gonna get lung cancer; somebody who knows you whose seen and who can - you can trust to kind of guide and manage your health, right?

Chuck Bryant

Right. They're kind of a dying breed too, sadly.

Josh Clark

Definitely and there's a good reason why, Chuck. You read that CNN article.

Chuck Bryant

Yeah, that was distressing.

Josh Clark

Actually, it was an editorial by Dr. Vance Harris, I believe.

Chuck Bryant

Yes.

Josh Clark

And he basically gave a rundown of why the primary care physician is becoming a dinosaur, right?

Chuck Bryant

Yeah, it was pretty depressing actually.

Josh Clark

So he was saying that for every several thousand dollars, he saves the healthcare industry by using his medical training to actually make diagnoses rather than really expensive screenings like MRIs.

Chuck Bryant

Treatment as opposed to procedures.

Josh Clark

Um-hum. He said that for every thousand dollars he saves the industry, he makes $50, $75. So he's - primary care physicians are not making a lot of money. What's more: there's a lot of issues surrounding malpractice.On one hand, you can say well, the very fact that there's malpractice lawsuits out there and they often add up to astronomical amounts of money being paid out to people who are found to be the victim of malpractice, doctors are a little nervous about relying on their training to make a diagnosis when there's an MRI machine in the next room that they can just say, "This is gonna solve it one way or another. I'll know for a fact. And then at the very least, even if I miss it, I can say well, the MRI manufacturer screwed up." There's a lot of passing the buck because of that supposedly, but there's another way of looking at that, correct?

Chuck Bryant

Well, medical malpractice is - you hear a lot about doctors saying, "That's driving us out of business. We can't afford the premiums. We have too many patients. We're having to squeeze in patients that come in for - because they're worried." I know cyberchondria feeds into it. People read on the internet, "I've got reflux. I need to get an endoscopy." And they go in there and demand one.

Josh Clark

Which really it's your right. You're a patient and you wanna make sure that you have a healthy body.

Chuck Bryant

It's tricky business though.

Josh Clark

It is because - what did you call it: cyberchondria?

Chuck Bryant

Yeah.

Josh Clark

Excellent. It's an argument that's often used against pharmaceutical companies advertising on television. You get the impression that they are educating the consumer to say, "Here's the words you use when you talk to your doctor to get our pill." How much of an effect has that had on - over prescription?

Chuck Bryant

I'm sure a bunch and there's so much information out there now. That's the first thing I do. I diagnose myself on the internet all the time and I know a lot of people do that.

Josh Clark

Do you really?

Chuck Bryant

Oh yeah, man.

Josh Clark

What do you have?

Chuck Bryant

I've got reflux and -

Josh Clark

Do you?

Chuck Bryant

Um-hum, big time.

Josh Clark

You're not much of a complainer, Chuck.

Chuck Bryant

Oh, shut up.

Josh Clark

Really, I had no idea you had reflux.

Chuck Bryant

I have bad reflux dude.

Josh Clark

Let's take it back to -

Chuck Bryant

Can we talk about malpractice again real quick because I do have a study?

Josh Clark

Oh yeah, please.

Chuck Bryant

So you hear a lot about how those costs are driving doctors out of business. And I'm not saying one way or the other. I'm just gonna throw this study out. The Americans for Insurance Reform, they're a coalition made up of Consumer Federation of America, consumerwatchdog.org and 100 other public interest groups. They released a study this week that found that malpractice premiums are down at the lowest they've been in 30 years. Malpractice claims are down 45 percent since 2000 and in states where the states have limited the consumer's ability to sue for malpractice, premiums are about the same as in other states.

Josh Clark

Really?

Chuck Bryant

So I'm not saying they're not paying a lot and it's not putting a dent, but they do say that malpractice claims only constitute one-fifth of one percent of annual healthcare costs in the United States.

Josh Clark

So that's kind of an obsolete argument these days?

Chuck Bryant

Well, it may be a little overblown. Of course, tell the doctor that that has to pay a lot of money, but from what I read, it's not the central problem like some people say. It needs reform; it needs to be controlled by the government: who knows. I'm just here to report the facts.

Josh Clark

And you did an excellent job of it.

Chuck Bryant

Thanks.

Josh Clark

Let's go back to talking about where you get your insurance. We talked about employer based plans. We talked about people who get their insurance individually, people who get it from the state. And then there's another group known as the uninsured.

Chuck Bryant

Yeah. And this is where it gets really hinky. The number of the uninsured is kind of all over the map right now.

Josh Clark

Well yeah, and also, it's one of the central foci of the insurance - or healthcare reform debates -

Chuck Bryant

Well, it has to be.

Josh Clark

- that there's 45 - actually, as far as August, 2009 Census Bureau figures, 5.6 million uninsured Americans. And that if you are a person who believes that healthcare is a human right, you think that these people should be covered in some form or fashion, right?

Chuck Bryant

Right. And they're really nitpicking this number because this number, the number of uninsured, is largely what a lot of the financing is gonna be based on. They're trying to project to like a decade into the future, and if they don't get that number right, the money doesn't work out, then that's when you're really screwed.

Josh Clark

Well, sure. You were saying that not everybody's on the same page with who the uninsured are, how many there are. There's a guy named Michael D. Tanner of the Cato Institute and he pointed out that -

Chuck Bryant

Our favorite think tank, right?

Josh Clark

Actually, I'm more of a Brookings Institute fan.

Chuck Bryant

Oh man.

Josh Clark

Cato is pretty good.

Chuck Bryant

You used to be all about Cato.

Josh Clark

I was. I've - I still am, but I like Brookings these days.

Chuck Bryant

You've changed.

Josh Clark

So Tanner points out that about 12 million of the 45.6 million people who are uninsured in the US are eligible for Medicaid or S Chip; they just haven't signed up.

Chuck Bryant

True. Well, maybe true.

Josh Clark

That's a really good point. He also points out that if they ever go in for treatment that should pop up in whatever patient data that the administrator takes in and they'll be automatically enrolled in whatever program suits them. So that takes care of 12 million. One of the ones I don't necessarily agree with and I think that people who think that healthcare is a universal human right would disagree with very much is he points out that about 10 million of these people who are uninsured in America aren't Americans.

Chuck Bryant

That depends on - when you start looking at these numbers - I started looking around. People are throwing all kinds of numbers around.

Josh Clark

Everybody's got a number for this.

Chuck Bryant

It's because it's hard to count and account for these people. Generally, illegal immigrants aren't gonna step forward and say, "Count me on your report." So that's one reason.

Josh Clark

Right, but Tanner also makes one last point that you and I are kind of anomalies in having gone several years without insurance when we were younger men; that about 50 percent of the uninsured in the US go six months or less without insurance. So really this 45.6 million Americans, even if the number remains the same, who makes up this population is changing constantly.

Chuck Bryant

Right, it's a snapshot basically or as one person put it in one of the articles you sent me.

Josh Clark

So yeah, exactlyhow many uninsured people there are and who they are is kind of a big part of this debate about whether healthcare needs reform. Actually, let me correct myself. I haven't run across anybody who says healthcare doesn't need reforming. Have you?

Chuck Bryant

No.

Josh Clark

No. Everybody agrees that there is something wrong with it.

Chuck Bryant

That it's broken and the World Health Organization would probably agree with that statement.

Josh Clark

Well, hold on. Let's first talk about some of the different arguments. There's some people who say that public healthcare is nothing more than just a weak part of the American state and why should my taxes pay for some other guy's health insurance when I'm paying through the nose? The - you could say that competition might ease this. Giving people vouchers to go buy their own insurance might make them a little more penny wise with how they spend their money. Really, ultimately, what seems to be agreed upon by everybody is that the American healthcare system is too expensive for what it provides.

Chuck Bryant

Big time.

Josh Clark

So let's talk about this. You mentioned the World Health Organization. This is huge and this still - this study was from 2000 and it remains a real piece of ammunition that's used many different ways on the debate on healthcare reform.

Chuck Bryant

Yeah, it was a groundbreaking study. And like you said, we are the most expensive. We spend more money on healthcare than anyone in the world.

Josh Clark

We spend 16 - in 2008 we spent 16.6 percent of our GDP on healthcare; not just government spending, but just across the board. 16.6 of the percent of the market value of the United States in that year was spent just on healthcare. That's more than defense, buddy.

Chuck Bryant

I know.

Josh Clark

We were in Iraq and Afghanistan at that time.

Chuck Bryant

If you give me a number like that, I would say in response, Josh that of the 191 countries they studied, then that probably means that we're at the top of the list then for what you get for your dollar.

Josh Clark

You would think we should be since we have the most expensive and technologically sophisticated healthcare system in the world.

Chuck Bryant

We're top five, top ten.

Chuck Bryant

You would think.

Josh Clark

Oh, where we should be?

Chuck Bryant

Yeah.

Josh Clark

Top five, easy.

Chuck Bryant

Yeah, but I'm gonna give you some leeway and say top ten.

Josh Clark

Okay, what is it really? Where do we rank?

Chuck Bryant

37.

Josh Clark

37th in the world; out of 191 countries?

Chuck Bryant

Yes.

Josh Clark

And you know who was just above us? Costa Rica.

Chuck Bryant

Awesome.

Josh Clark

Do you know who was just below us?

Chuck Bryant

Who?

Josh Clark

Slovenia.

Chuck Bryant

Wow.

Josh Clark

Yeah. That's where the US ranks.

Josh Clark

Nothing against Slovenia, but yeah, since we have the most expensive healthcare system in the entire world on the planet, we should by proxy, have the best healthcare system as rated by the World Health Organization.

Chuck Bryant

Do you wanna hear something else chilling?

Josh Clark

I do.

Chuck Bryant

Americans' life expectancy is lower than Canada, half of the Caribbean, including Puerto Rico and Cuba, Chile, all of Western Europe, some of Eastern Europe, Israel, Jordan, Singapore, Hong Kong, Japan, Australia and New Zealand. Our life expectancy is lower than any of those countries.

Josh Clark

Wow.

Chuck Bryant

And I'm not necessarily saying that definitely means that their health care system is so much better, but it probably lends itself to that argument.

Josh Clark

I know the study you're referring - or the article you're referring to, Chuck and it references a study from the New England Journal of Medicine from about ten years ago that showed that the average black man in Harlem was less likely to reach age 65 than a man in Bangladesh.

Chuck Bryant

That is messed up.

Josh Clark

That's not supposed to be.

Chuck Bryant

No. Not when you're spending the - and we're not saying becauseAmerica's so much better. It's because we spend the kind of money we spend. We expect better results.

Josh Clark

Right. And that's one thing that a lot of people have agreed on. The other point to this is - by the way, we spent $2.4 trillion in 2008 on healthcare. Healthcare spending and costs continue to increase, but as someone else pointed out, in 1996, our mortality rate flattened. It hasn't gotten better since then. So in short, the US is not getting enough bang for its buck as far as its healthcare system goes.

Chuck Bryant

We're not getting healthier, but we're certainly spending more money.

Josh Clark

What's going on?

Chuck Bryant

Well, there's - there's a lot of reasons. I know one thing a lot of people point at is the aging baby boomers are now at the age where they need a lot of care in the hospitals and by doctors. There are fewer and fewer doctors and nurses, so they're not getting as good of care. And there's more - I think they just call them medical errors in the article I read because of under staffing. That's one reason.

Josh Clark

What you're talking about could actually be considered symptoms. And we should probably say just for COA that if you put Jerry and Matt in here, you would get a totally different podcast with all the same research. There are so many ways of looking at this issue that all you and I can do here, Chuck is try to get to the central focus of it without leading into partisan politics or anything like that. It seems to me, from what I saw come up time and time again from sources on both the left and the right, pro business, pro labor is that theAmerican healthcare system is too sophisticated. It's too advanced and patients have too much access to it; too much you could say frivolous access to it. So the MRI scan we were talking about, the one -

Josh Clark

Right, the patient demands it because that money that goes toward your employer based insurance policy comes out of your paycheck. And when - so right there this is money you haven't even seen. It comes out before your paycheck's direct deposited into your account. Secondly, it's relatively cheap. And when you go to the doctor you're not actually shelling out money.

Chuck Bryant

No, your co-pay.

Josh Clark

Right. So you have no real incentive to be cheap.

Chuck Bryant

What was The Simpsons episode you were talking about?

Josh Clark

Do you remember the one where Homer and Lisa go into isolation tanks?

Chuck Bryant

Right.

Josh Clark

Which by the way, I did recently and it was cool. And Homer's isolation tank is repossessed while he's in there. And one of the laborer's who's repossessing this thing tells the other one to lift with his knees. And the other one goes, "Screw it. I've got health insurance."

Chuck Bryant

Right. And that's kind of the attitude some people take is, "I'm paying for this; I'm gonna get my money's worth out of it. So I've got some heartburn; I'm gonna go demand the camera down the throat instead of trying to treat it and see if - or not eat chocolate and red wine right before I go to bed."

Josh Clark

Well, that's the other thing that it betrays is that we aren't taking responsibility for our own health. As Americans, we don't.

Chuck Bryant

And that's where it has to start, buddy.

Josh Clark

Definitely. And part of that is putting that focus back on prevention again rather than treatment because consider this: if you have an advanced disease, how much more rigorous is your treatment going to be? How many more doctors' visits does that entail? How many more scans does that - MRI scans does that entail? How much more medication? And don't get me started on the pharmaceutical companies.

Chuck Bryant

Yeah, that's a different podcast.

Josh Clark

How much more time and effort and just cost is it going to take to treat an advanced stage disease than it's going to be to prevent it or treat it early on?

Chuck Bryant

Exactly. So like when they recommend at I think 40 or so for women to start getting your mammogram and for men to get the old how's your father treatment from your doctor. These kind of things - people -

Josh Clark

My poor dad.

Chuck Bryant

People avoid this stuff. And then all of a sudden, you have like you said, holy cow. I've got a tumor that's in an advanced stage because I haven't taken care of myself and I haven't done the regular check-ups like I need to. And they cost a lot more.

Josh Clark

So this infrastructure that we're talking about, the health system infrastructure, it keeps growing and growing. It costs a lot to manufacture an MRI machine. And I keep using that, but it's just such an easy example. And as a result of just - of not just that MRI machine, but all of these different external factors and possibly corporate greed. From 2004 to 2009, the average cost on healthcare premiums increased four times faster than the average wage in the US. So all of a sudden, healthcare's just getting more and more and more expensive. And not just for you or me, Chuck.Our premium from 1999 to 2009, the employee contribution went from an average of $1543 to $3,354. That's just our contribution. This isn't including employers' contributions, which is affecting their bottom line. And as healthcare costs rise, they're losing a competitive edge in the global market in an increasingly globalized world.

Chuck Bryant

And all businesses have budgets. They work on budgets. That also might affect the raise you might or might not get because of the budget and how much they're having to spend. I know my father-in-law has a small business and he has a really small business. He only has a handful of employees, but he has a health insurance program. And one of the ladies that works with him is one of these people that does not take care of herself. She has like three or four surgeries a year. And it's driving him out of business; this one lady. And let me tell you something else, buddy.

Josh Clark

What?

Chuck Bryant

The World Health Organization estimates that between 19 and 24 percent of the total dollars spent on healthcare here is spent on administrative costs.

Josh Clark

Wow.

Chuck Bryant

Administrative costs.

Josh Clark

Yeah.

Chuck Bryant

And another reason that it's so expensive is there's been a big shift - I don't know if you've noticed for-profit hospitals as opposed to the old non-profit model.

Josh Clark

Yeah, the community model.

Chuck Bryant

And that's kinda helped drive up prices too, so they say.

Josh Clark

Well, sure and not only that, but the uninsured drive up prices. The Medicaid and Medicare are notoriously terrible on paying out billing to physicians. Hospitals have started to use something called balance billing where they start billing patients for procedures they didn't know they weren't covered for and the insurance companies are refusing to pay. And all of a sudden, you've got a collection agent all over you because the hospital didn't say, "Oh by the way, this doctor right here who you're about to see is out of your network. So you're gonna have to pay for him out of pocket." There's just - we have big problems here.

Chuck Bryant

Yeah, no kidding.

Josh Clark

So Chuck, how do we solve this?

Chuck Bryant

I have no idea.

Josh Clark

Other people do.

Chuck Bryant

Thank heavens for that.

Josh Clark

Well, one of those people is a man named Mr. Barack Obama. You may know him as President Obama. He's got a plan for healthcare reform and we're gonna cover that in the next installment of the podcast, Barack Obama's Healthcare Reform Plan: Soup to Nuts.

Chuck Bryant

Yes.

Josh Clark

But again, this is kind of a weighty topic and we're gonna need some help. So we're gonna recruit Molly Edmonds, right?

Chuck Bryant

Molly Edmonds of Stuff Mom Never Told You, our popular sister podcast and all our healthcare writers.

Josh Clark

Well, yeah. She's been completely submerged in healthcare for the last three weeks.

Chuck Bryant

Health in general. She's our writer.

Josh Clark

She is, but she's been studiously studying healthcare reform. So she's gonna come in for the next few podcasts to help us sort through things.

Chuck Bryant

Good.

Josh Clark

We can rely on her a little bit. And also, I just spoke to Dr. Michael Roizen who is the chief wellness officer of the Cleveland Clinic and more famously known as co-author of the You: The Owner's Manual series of books.

Chuck Bryant

With Dr. Oz.

Josh Clark

We got him on the phone. Yeah?

Chuck Bryant

He was so awesome.

Josh Clark

So it's gonna be like a whiz bang super big healthcare reform podcast and hopefully, by the end, you will know as much as Molly Edmonds which is substantial. So stay tuned for the second episode which will be out in a week. And in the meanwhile, you can go to howstuffworks.com; type in healthcare in our handy search bar and you're going to find a slew of really thoroughly researched and well-written articles by Molly Edmonds. And if you wanna send us an e-mail about healthcare or anything else, you can shoot that to stuffpodcast@howstuffworks.com.

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