the

Why American Healthcare is Failing | Dr. K Explains

can you imagine if you couldn't even

decide which video game like you didn't

even know like you've got some weird

nebulous

you pay 2 000 a month

and it's determined by your employer who

that money goes to

and like the video game company can do

like like can you just imagine like i

can't even

figure out how to frame this if

electronic arts

could enter into an agreement with your

employer to determine

how much video games cost

in which video games you play can you

imagine how bad that system would be

like it would be a complete train wreck

oh my god this is gonna be so painful

okay so do you guys know like how

american healthcare works like does

anybody have any idea like what happens

like let's start with the basics okay

insurance great that's a great place to

start so we're going to start here okay

so this is what happens so here's a

person

okay here is their doctor

and i can't really draw a stethoscope

but

that is a stethoscope okay and it seems

to be

on top of their head so you know good

luck with that to a chat

because my drawing is terrible

all right and then here's the insurance

company

so here's the first thing to understand

so you know generally speaking what

happens

is um you know

when i want a good or a service i pay

money

and then i receive the good or service

right like let's say that i walk into

the grocery store and i say i want to

buy an apple like i pick up an apple off

the shelf i go to the checkout counter

and i say

i would like to purchase this apple and

then the other person says

okay the apple will cost you one dollar

and i give them the dollar

and then i receive the apple and then i

take a bite of the apple and i said the

apple is bad and then i go back and i

say hey this apple is mealy and it has a

worm in it i would like my money back

and then the person at the cash register

says i'm sorry all

sales are final and we can't accept an

apple that has been bitten into

go screw yourself and then i feel

frustrated and i walk out and i decide

i'm never going to purchase an apple

from them again

so that's good because there's like

feedback between

like my purchasing power can be

controlled based on my preferences and

experiences

so here's what happens in

our health care system okay so

what i purchased

i give money to the insurance company

okay and then i go and i get a service

let's call the service yellow from the

doctor

and then what happens is the insurance

company

pays the doctor for my service

so the first thing is that this is like

a messed up system from feedback because

i don't actually control like there's no

like generally speaking what we would

want in a perfect world

is the money and the service to be

directly related so i can like have

feedback

based on you know if i don't like the

doctor then i can go to a different one

but like that's not how it works

so like here's practically what happens

right so i go see my doctor

you guys have to understand that i'm

biased about this okay because i'm a

doctor so i

i have a bias perspective so i go to my

doc

let's say i don't know if i'm the doctor

i'm the whatever but so let's say that

like you know patient goes to their

doctor and the doctor says we think that

you need this medicine

because i think this is what you need

and then

the the patient then tries to get the

medicine

but their insurance company says we're

not going to pay for that medicine

because this one is cheaper

so it's kind of like if if you go to a

store and then you ask someone

hey i want to barbecue tonight what do

you think i should get

and then like the grill master at the

store or the butcher says we have a

really great this like i think this

would be really good and it will really

be what you need

and then you kind of like say okay i

want to get like a a rack of baby wreck

ribs and then some other guy comes in

and says

yeah we're not gonna pay for the baby

back ribs because

you know pig feet are cheaper and then

you're like

but the expert told me that i should get

baby rack ribs and then the

this other dude is like yeah man sorry

like we're not gonna pay for that

because the pig feet we've done studies

or we believe that like people who eat

pig feet are just as like healthy as

people eat baby back ribs it's all [ __ ]

anyway it's all pork

it's all unhealthy so we're not gonna

pay for the baby jack grips

and that's really frustrating for me as

a physician because what the insurance

company does is they're like basically

like

they're the ones with the money so it's

kind of like it's kind of like you go to

the store with your mom

and your mom is like you're like hey can

i get this thing mom and you gave her

your allowance and she's hanging onto

your allowance

and she's like no man like you can't get

that thing because i don't think it's a

good idea

and it's expensive but you're like but

it's my money and then your mom's like

no but i'm like holding it for you so

i'm gonna say no

so the first thing that i find

frustrating about the the health care

system is that

you know the insurance company actually

has a vested interest

in taking as much money as they can from

the

the patient and then providing the least

amount of care possible because that's

like

their incentive is not actually in

helping patients their incentive is in

charging

as much as they can and then like

delivering as little health care as

possible

right so it's kind of like i mean a

simpler analogy is like you know

i want to go and like i said i tell my

patient hey i think you should like eat

an apple every day

and then they're like okay so can i have

the apple and the insurance company is

like nah man

we're gonna get you a sack of potatoes

and then you're like but dude i want an

apple and they're like no we think like

potatoes like if you look at the calorie

nutrition information apples are 100

calories of potatoes 100 calories so

we're going to give you potatoes

and then as a physician what i have to

do because what happens is because

potatoes are cheaper right

so like even though the apple is better

for the person than a potato because

potatoes have no vitamin c and they have

scurvy so i'm like you should really eat

an apple

then what i have to do as a physician is

i have to send a form the insurance

company says oh you can get an apple

absolutely we wouldn't want to deny you

an apple all you have to do is send us a

form

you have to fill out this one two-page

form about why the patient needs an

apple

and then we'll give them the app and so

essentially what they do is they they

create an administrative burden

for like doctors to give medicine to

their patients that their patients need

and so then what happens is like doctors

like it's very frustrating to fill out

forms and i have to fill out forms for

all of my patients

and so then what happens is like they

basically have they hire someone

so instead of paying for the apple what

they do is they hire someone

to review all these applications and

then make judgments about whether

they're going to pay for it or not

depending on the clinical information so

it makes sense but then what happens

is like there's they hire someone to

essentially like block

the apple and basically pay less money

and they make it really hard for

patients to get care and then what

happens

by healthcare providers is we realize as

doctors like i don't have two hours a

day just

to fill out forms and fax them to the

insurance company so i

i hire someone to do that process for me

so essentially what's happened

is that like the patient is still

getting the medicine at the end of the

day they're still getting the apple

but what's happened is we've increased

costs on the insurance side

because they have someone who's blocking

the apple and we've increased

costs on this side because i've hired

someone to make sure that that

that they don't block it so we both

hired an additional person to get the

person the apple

so now we've just increased

cost just across the board we've

increased costs

so the patient actually has to increase

their premium

right so now i have to build a patient

more

so this number goes up this number

goes up because of this and this

with no improvement in care

so one person says creating jobs fine

so that's the first thing okay so then

so like this is just super messed up

because like it you know the insurance

com

like and actually there are some good

reasons for this so the counterpoint to

this is that oftentimes doctors will do

things

so doctors have a financial incentive to

deliver the most expensive care to

patients

um and this actually gets worsened by

the insurance company because

what then everyone thinks is like if i'm

not billing the patient directly if the

insurance company is paying for it

i might as well do the most expensive

[ __ ] so like if i can get away with ct

so let's say a ct costs about

200 let's say an mri costs about 900

and if i'm billing insurance for it and

i get paid 900

or like let's say that my profit here is

300

and my profit here is 100 if i'm a

physician

it's my incentive to order as many mris

as i can as opposed to ct scans

because i make money more money with

mris

right so a ct scan is a cat scan and an

mri is a

magnetic resonance imaging there are two

kinds of imaging

techniques now the interesting thing is

that if i was billing the patient

directly

i would actually like consider that

right so doctors do do that because like

if i have a patient who's broke i'm not

going to charge him like 900

to go bankrupt because that's just not

generally speaking how the people in my

profession work like if you've got a

customer

and they can't afford something you're

going to try to like keep that customer

happy by doing like whatever you can get

away with

right so i i very much consider my my

patients financial needs

in terms of trying to come up with like

prescription plans and stuff like that

we try to

you know help people out with that and

that sort of makes sense like if you go

to a store

and you have like a relationship with

that business and the business is gonna

try to sometimes sell you the platinum

thing but if they can't sell you the

platinum thing they're going to like

try to at least sell you silver

so i don't know if people can agree or

disagree with that but you know

doctors definitely have or health care

systems definitely have a financial

incentive to order more tests

and the problem is that like with the

insurance premium

this guy's money essentially stays the

same

right like whether i uh do an mri or ct

scan

they just pay a co-pay and the cost that

actually gets increased here

is the insurance companies

so that actually goes up if i choose an

mri over ct

so then what happens is doctors are like

okay like the patient is paying the

premium anyway

the premium is fixed so we might as well

order as much [ __ ] as we can because

like

they're not paying for it i'm not going

to screw the patient it'll be good for

them

i don't have to worry about costs

because the insurance company greedy ass

insurance companies are taking the money

anyway so we might as well like order

the most expensive ship

and that sort of makes sense right but

at the same time it actually still

increases costs for the whole system and

then this

cost gets passed back to him in terms of

increased premium

because the insurance company ain't

going to go out of business so they're

like okay if the the doctor's billing

all this crap

one thing that we can do is we can go

back to the prior auth

so if you want an mri instead of a ct

scan

you have to send us additional paperwork

and then i'm like okay that's fine

i'm gonna hire another person to make

sure that all the prior authors go

through

so now we've sort of increased

yes screwed up incentives all around

okay

so yeah i mean the mri can be in the

third party that's fine

but the point is that the doctor if the

patient isn't gonna have to pay for it

the doctor is gonna uh

uh actually a doctor can't order an mri

i mean they can't profit from an mri

technically

um so like when i order tests for my

patients i don't

i don't make any money off of them so

but i i still really don't give a [ __ ]

because the insurance company is going

to pay for it so i'm like you guys are

paying the premiums anyway so like you

might as well get the best healthcare

you can

my point is that like all the costs like

end up so i don't know if you guys get

this but all the costs are like landing

on this dude

poor guy okay so i mean this is even

getting worse

it's gonna get worse okay so

then the problem is that like health

insurance is so expensive

that do you guys know who pays for most

health insurance in this country who

decides

how do humans get how do people in their

how does the average american get their

health insurance

employers right so now oh man things are

about to get wild

okay so now we see a third problem this

is just gonna

get worse because the the patient

doesn't even have control over which

insurance company they use

that's determined by this guy

right so it's like if if the patient

says i don't

like how much you charge me for my

premium or i don't like

that you're not paying for this

treatment that my doctor recommends

the patient can't even switch insurance

companies

they have no recourse there's no sense

of feedback

in terms of choice within the health

care market

so i don't know if you guys get this but

when you don't have a choice

in a market then you're screwed

right so like like right now i mean

people talk about how predatory video

game

providers are and i think that video

game providers are like

they're like kindergarten compared to

like the nba when it comes to like

health insurance companies

because at the end of the day you still

get to decide which video games you

purchase

and that choice about how much you spend

on skins or microtransactions or games

empowers you a lot and keeps costs low

can you imagine if you couldn't even

decide which video game like you didn't

even know

like you've got some weird nebulous you

pay two thousand dollars a month

and it's determined by your employer who

that money goes to

and like the video game company can do

like like can you just imagine like i

can't even

figure out how to frame this if

electronic arts

could enter into an agreement with your

employer to determine

how much video games cost

in which video games you play can you

imagine how bad that system would be

like it would be a complete train wreck

and so now now let's think about the

employer's incentives okay

so what are the employers incentives

there is no tldr the whole reason this

is a dlc

or the tl dr is the system is [ __ ]

but no no so their their incentive is

not to hire healthy people

right so the insurance company wants as

many healthy people as it can get

for as high of a premium it can get

so yeah absolutely so people are saying

worst cheapest plan possible so the

worst

cheapest plan possible to get the

employees that they want

right so now what they're doing is they

kind of like

they figure out like okay so we're gonna

try to

give the insurance company

a tiny dollar sign and we don't want to

give them a big dollar sign we want to

pay them as little as possible

but there's something that's really

bizarre which is that since the employer

has

500 customers

right because they have 500 employees

they actually get a better rate from the

insurance company because they're buying

in bulk

so that actually keeps costs down the

problem

is that when if you try to buy insurance

directly from it

from an insurance company you get no

bulk discount

so what this means is that you have to

get insurance through your employer

because it's going to cost twice as much

so i'll give you guys an actual number

okay

i pay about 2 800 a month for my

family's health insurance

for the same plan that is not through my

employer i can't even get the same plan

for a plan that is worse than the plan

that i have right now

if i buy it directly from the insurance

company

it cost me four thousand five hundred

dollars

yeah i'm buying family health insurance

so family health insurance is

expensive four thousand five hundred

dollars a month

right absolutely 50k

in insurance premiums so then what

happens is they're all these kinds of

weird like things because the employer

sort of

kind of doesn't give a [ __ ] right so

they come up with all these weird like

plans and i don't know if you guys

understand this but the more complicated

a financial instrument is

the more you're getting screwed so like

insurance plans

have different ways of screwing you okay

so let's just think about a premium

a deductible

a copay like do you guys see like

they're gonna [ __ ] you with each of

these the premium is

amount okay so this is

[Music]

dollars you pay per month

this is dollars you pay

before they

pay anything

this is dollars you pay

no matter what

and then you have maximum

dollars okay

this is max

dollars they pay

after which

you pay everything

okay this doesn't even

this doesn't include pre-existing

conditions so like you guys see how

complicated this is like

this isn't an apple okay so like let's

let's use this in the grocery store

analogy

so in order to shop at our grocery store

you need to pay us a hundred bucks a

month

the thing is if you shop at our grocery

store we'll pay for your fruit

you have to pay us 100 monthly fee okay

great

but there's a deductible how much is the

deductible it's 500

so we're gonna pay for all of your fruit

after you spend five hundred dollars

here

and you have to pay us a hundred dollars

a month anyway

okay fine even then when you when you

come in

after spending the first five hundred

dollars of fruit and you're paying us a

hundred bucks

uh you have to pay up you're paying me a

hundred dollars

and then you still have to pay the

grocery store five hundred dollars

before we'll pay the grocery store

anything

after you pay the grocery store five

hundred when you go buy an apple you

have to pay a copay

so we're gonna when you buy an apple

we're gonna pay 80 cents and you're

going to pay 20 cents but the first 500

bucks you have to pay all of it yourself

and then if you buy a thousand dollars

worth of fruit above that we're not

going to pay anything

so like that's just

like bizarre like there's so many

variables in that equation

and then what happens is like it's

confusing like because people don't even

know what they're paying for

like it's bizarre so i don't know if you

guys like know anything about financial

instruments but like

you know the more complex the financial

instrument like the worse it is for you

so annuities are a good example where

they're like you know they'll

be some weird like life insurance

instruments that they'll like pay you

some amount after some amount of years

and if you die you get this

if this happens you get this and if this

happens you get this the more

ifs there are in the system chances are

the more you're getting screwed

chances are because sometimes you need

ifs in the system

but then what happens is like this is

the decision-making process

and then like like what is a good health

insurance plan so then like your

employer is like okay well

then they like move all they adjust all

the levers right and then your employer

is like yeah we have great health

insurance

they'll cover five million dollars worth

of care but the question is

so they say that we have a five million

dollar policy

great but what's the deductible fifty

thousand dollars

oh [ __ ] what's the premium five thousand

dollars oh [ __ ]

what's the copay hundred bucks

oh [ __ ] right so there are all these

different levers and it's just like

confusing because if you're not happy

with something like i don't even know

who you go to like the basic problem

with this is that

you know this person should be empowered

to make the most decisions right this is

what everything is about it's not about

this guy

it's not about this guy it's not even

about me like i should like

these three people should have the least

power in the relationship

this person should have the most power

generally speaking you want to give if

you want like a healthy

market you want to empower the consumer

right like you want the consumer like

you know good video games happen because

gamers

like generally speaking i mean some

gamers buy [ __ ] games but

like part of the reason that i think we

have so many good games now and you guys

are welcome to disagree with me

but i think that like part of the reason

we have so many indie games is because

people are out there like

buying games that they want to play and

it supports indie developers

it's not like nhl 2015

then nhl 2016 nhl 2017 nhl 2018.

it's like we've got cool games like like

we've got you know

what are a couple of like i've been

playing northgard recently in drg and

like

you know they're like all these cool

like indie games

right that i mean i really like because

and we also have like big budget games

that are awesome like breath of the wild

like that's an awesome game like there

are a lot of great games out there god

of war on ps4 is awesome

jedi knight fall in order which is an ea

game oh my god ea

they're so evil but jedi knight is a

fantastic game

and so as long as your consumer like as

a as a video game consumer

yeah dark souls hollow knight larian

awesome

cyberpunk 2070 27 7

2077 whatever

right like all these games are cool we

also have like starcraft brood war

like that game is pretty awesome people

say good things about diablo 3 i never

really had a chance to play it love

diablo 2.

um yes of t5

so this is how the healthcare system

works

right and it's a mess because i think

the consumer doesn't actually have

choice

you have to pick you have to get health

insurance through your employer because

your employer

gets a significant discount and then the

last thing is like

you know like costs just get passed down

costs

just get passed down passed down passed

down to the

the the patient

because here's the thing i don't know if

you guys know this but health insurance

companies are not going out of business

doctors are not going out of business

employers are not going out of business

and so no matter like what

how you squeeze like if the doctor

starts prescribing expensive medicine

to the insurance company the insurance

company is going to increase their

premium

or sorry if you prescribe expensive

medicine to the patient and the

insurance company has to pay for it

they're going to jack up their premium

and then employers are going to kind of

jockey to sort of provide the worst

health insurance they can

to keep people employed and oftentimes

that they do their best to

provide like no insurance or just

absolute crap insurance there are a lot

of good employers out there who like try

to provide good insurance

um and and it's just the costs are

astronomical it's like it's not

you know it's like really kind of crazy

like so you know my

my health insurance my employer paid a

portion of

so when i say it's like 2.5 k that's

something that i'm paying out of pocket

through the nose

because i'm on cobra now don't even get

me started there

but before that i used to pay like half

and my employer would pay half

and i just decided i wanted good health

insurance because i had like you know a

wife who's having kids and [ __ ] like

that so

um and i'm lucky because i can afford

that and it's like absolutely

astronomical

and so this is how it works here's the

healthcare dlc

questions

yeah cobra is ridiculous

yeah so i didn't even get started on all

kinds other stuff like ppo

hmo all that stuff i mean that stuff is

even worse

like i i don't even know like this whole

okay so like one more rant okay so like

the idea that

so i try not to talk about politics and

i really don't think this is politics

but it's become a political issue

so should everyone in this country have

health insurance ideally the perfect

environment would be

one where the consumer in the health

care provider

have a direct relationship where it's

like

person

doctor and then you just it's just

two-way right because then you have the

most so

money service

the second that you add a third person

things get really messed up

you guys see that it's like

that's weird right so you pay this guy

this guy pays your doctor and it's like

what

like this is increasing costs by like 30

or more 40 right so there have been

studies that show that like

if you look at the cost of health care

for like every one dollar

in insurance the insurance industry is

like 30 to 40 percent of that dollar

and the thing that boggles my mind is

basically the only thing they're

providing

is like risk hedging

right that's the main value of an

insurance company

is that you may not have the money to

pay for cancer treatment

so essentially what insurance companies

do is they say we're going to charge you

a thousand dollars

a month and then if you get cancer we'll

pay like 50 grand for your cancer

treatment

and they do that with 20 people and so

they hedge risk so that

if something catastrophic happens to you

it's like it's insurance right so it's

about

hedging risk and what they really

provide is hedging risk

and that's a valuable service don't get

me wrong but it seems like they cost 30

to 40 percent of like

every dollar that gets spent like

hedging risk and spending 30 to 40

percent of your money

on like hedging risk is ridiculous

okay so what was i going to rent oh yeah

so uninsured

okay so then the other interesting thing

is people say like oh like you know

universal health care is good or

universal health care is bad like this

is the other thing that i think a lot of

people don't realize

so when someone without insurance

so let's say this person with insurance

you guys want me to keep going because

this is is this interesting to you

should i stop

okay all right so now this is this is

gonna blow y'all's mind okay

so let's say there's a hospital

okay

so let's say someone with insurance goes

to the hospital

okay and receives a service

how does their service get paid for

okay

insurance plus copay great so now here's

our insurance person right

so this is what happens so this hospital

gets paid

so let's follow the money guys remember

always follow the money

so money goes there right so we're

paying

this and then this person is paying this

so who pays at the end of the day who

pays

for the health care that's provided

the patient absolutely okay great so

let's say a person without insurance

goes to the emergency room because

they're having a heart attack we're not

even going to get into the whole

part about preventive care and saving

money and all that kind of crap

okay we're going to just avoid all that

for a second so let's say

the

so who pays for the health care that the

person without insurance

so who pays for that service

taxpayers okay how talk to me

my tax money how how does your tax money

pay for his health care

nope doesn't have medicaid

okay hospital takes a loss okay

so that's actually sort of

true so the hospital takes a loss

but you guys are right you guys are

right so now

let's this is the part of the story that

most people don't know so then the

hospital

goes to the u.s government

and says u.s government

we are taking a loss by caring for these

people

and we're gonna go out of business and

we're gonna have to shut down the

hospital

unless you guys pay us to stay in

business because

twenty percent of these people are

uninsured and each time they come to the

hospital it costs fifty thousand dollars

we're gonna have to close our doors

unless you give us money

and then what happens to a chat

right the government says okay we don't

want you to close your doors because

then they're gonna be people dying in

the streets so we're going to pay you

money

and now wait for it twitch chat where

does this money come from

taxes right

and so this is the crazy thing so there

are a lot of people

in this country who don't want universal

health care

what they don't realize is

they're paying for everyone's health

care anyway

because hospitals are not going to take

a loss the other thing oh there's one

other piece of the puzzle that y'all

we forgot so there are two ways in which

this person gets

so questionable because like maybe

they're printing money

right so maybe the the you're

it's not coming through your taxes maybe

the u.s is just spending money

but when when the hospital takes a loss

where do they make up the loss

where do they make up their loss

charging who more absolutely the

insurance company

they make it up over here so they

increase the amount that they charge the

insurance company

which in turn increases the amount they

charge you

so like i don't know if you guys get

this but the problem with our health

care system is that this guy's getting

screwed all the time like all the time

no matter what happens

this is the guy that gets food so to

subside to stay in business because the

government doesn't give

hospitals that much money right so like

medicaid pays like

30 percent or like 60 or like some

ridiculous

amount of costs so in order

for the the hospital to break even what

they do is charge the insurance

companies more

so like i'll just give you guys an

example okay so

for a particular health care system that

i was studying

they charge they collect 250

on average for a 30 minute 20 minute

for a 20-minute psycho farm appointment

for a psychiatrist

from blue cross blue shield okay

so when you go see your psychiatrist for

20 minutes and they give you a pill

they collect about 250 from blue cross

blue shield

for that same visit for someone with

medicaid

they collect about seventy dollars

like why is there such a big difference

it's because

the providers make up for this loss

by jacking up prices to insurance

companies which then pass along those

premiums

to patients and then everyone saying 2.5

k

per month 4.5 k per month

in insurance premiums how the hell does

that happen

that's how it happens folks this is how

these at ridiculous premiums get

this is how it happens this is our

health care system

so being uninsured is better no being

uninsured is worse

because then the only care you get is

the emergency room

so like the whole point of insurance is

that insurance provides preventive care

so you never wind up in the emergency

room this is the thing that people don't

get

is that like the guy who never takes his

cholesterol medication or blood pressure

medication

we're all playing for him anyway so we

have a choice either we pay for his

heart attack or we pay

five bucks a month for his blood

pressure pills

or we pay like a hundred thousand

dollars for his heart attack

right no just don't buy health care is a

terrible situation

what if you're rich without insurance

you get screwed

that's what's happening in this country

people are getting screwed like even if

you're rich and you pay for health

insurance

you're getting screwed anyway everyone's

getting screwed like this is the dude

who pays for everything

this guy

right it's like anyway what if you feel

like

that's what happens to people right so

there's like so

with with obamacare which you know i'm

really don't care about people's

political affiliations like the

the obamacare was like sort of a step

into i think it was a necessary evil is

the way i'd

describe it but so what happened is that

like they made insurance mandatory

which is kind of interesting because

what they did is they forced all the

people

who don't need health insurance like

young 23 year olds to buy health

insurance

to subsidize the cost of the people who

are like old and sick and need health

insurance

yeah the system really is [ __ ]

um yeah so like it's interesting i saw

an article a couple months or about a

year ago about like

a nobel prize like a nobel laureate

auctioned off his nobel prize to pay for

his healthcare

because he was broke and he couldn't

afford it so he literally he literally

sold his nobel prize

to pay for his health care like it's

bizarre

how do you change the system oh man okay

so like i said

the first thing to do the

a better system would be this

this is the first thing so people talk

about you know socialized medicine and

obamacare and stuff like that

the real solution is to create a

scenario in which

the consumer has power over their dollar

because then when they're the ones like

the reason that everyone is screwing

this guy is because

this guy doesn't have control over his

own calling

like so the guy who doesn't have power

in the equation is the one that's going

to get financially screwed

right like

so what you've got to do is give the

consumer power

to choose you try to make it

as like that's the real solution what

that looks like i'm not entirely sure

but i think the first thing is to not

have an um

an insurance based system so not have

something where your insurance pays for

your health care but you pay for your

health care

so a couple of good examples of this so

singapore

requires all of its

i'm a little bit dated on this but

singapore requires

all of its people to save a certain

percentage of their

income into a health care savings

account

the interesting thing is that when you

so you can pay 30 grand in premiums

okay you can disagree with this however

you want to but i'm just going to offer

an alternative okay

30k in premiums

to insurance or you can have 30k

in an account

so the big difference here is that when

you are in control of the thirty

thousand dollars

you're going to be way more careful

about how you spend them

when your insurance is has your thirty

thousand dollars

they're not going to give a [ __ ] they're

just going to try to pay for as little

care as possible because they've already

gotten the money

it's like an hsa absolutely right so

like

i think the core idea so singapore also

has a couple of other things like they

have a safety net

and other kinds of like insurance-based

things but i think it's kind of an

interesting idea i think

at the end of the day so i'll give you

guys just another random example

okay so this is what i really think is

messed up

so in ancient china and this could be

wrong so i was taught this by a chinese

medical doctor but

i don't really know if it's true or not

in ancient china

this is the way that healthcare

reimbursement worked

you pay a monthly fee to your doctor

any month in which someone in your

family gets sick

your doctor does not get paid

fascinating huh completely different

completely changes perspectives and

incentives

the incentive becomes keeping you

healthy

as opposed to paying for care when

you're sick

yeah get sick just to [ __ ] with them

yeah i'm sure there are all kinds of

problems honestly there's got to be all

kinds of problems with that because like

what if your doctor tells you to do

something and you don't do it do you

does he still not get paid i don't know

maybe he fires you then i don't know but

like

like our whole our whole health care

system it's not health care it's sick

care

it's just like the incentives are

completely perverse

they're just like they're just all

messed up

so that's my health care rent like this

this is just ridiculous guys

this is even more ridiculous it's just

all ridiculous

so i i mean like i think that having a

single-payer system

is good in some ways because

at least uh because you know the

government and

they're going to be political statements

about this too so it's not really my

place but

so we do know oh so here's actually data

so let's do data okay so

so the administrative cost of insurance

is about 30 cents on the dollar

so the cost of having a private

insurance company in the system is about

30 cents on the dollar can anybody guess

what

medicare and medicaid's it

administrative overhead

is compared to 30 cents on the dollar

compared to private efficient insurance

companies

great i love it three to four cents

on the dollar

three to four cents their administrative

overhead

for administering health insurance is 10

of what a private insurance company is

and do you guys know what administrative

overhead includes

so here's the beautiful thing corporate

salaries are administrative overhead

right so like it's not my place to say

whether the government is corrupt or not

corrupt like i really don't know about

that but like i can give you guys some

statistics

and if you guys want references i have

references

let me see if i can find them that's

going to protect it

oh [ __ ]

let's just google it see

so

i'm not sure what i i mean i'm seeing

articles from the new york times

and other things but here

i'll show you

oh [ __ ] hey wall

so i i don't know if this is i mean

these aren't cited well

but medicare has an overhead of about

three percent private insurance has 25

to 30 percent that's wasted i don't know

it's washington post so it's not a

primary study i i think i've got the

primary

analysis somewhere um

i just have to get up but

yeah yeah so i i

that's what i'm saying i don't think

those are good sources so i'd have to

find the primary

i've seen i mean i've seen the primary

studies that are done in

like health affairs

care

so there's like new england

new england journal of medicine and

health affairs i think or where i've

i've read this stuff before and those i

think are pretty reputable sources

but y'all are also welcome to disagree i

you know

common media i i just don't trust as

much as like primary like

literature um

here we go so this is also a blog

um but health affairs is a pretty good

source

yeah so of course oh so so for common

yeah so this is like cms.gov so

this is a good resource right so

medicare spending rose by an average of

4.3 percent

private insurance so this is a good

source

this so now twitch chat like if you guys

want good sources

this is the good stuff man cms.gov baby

like not new york times not washington

post you go straight to cms.gov

it's like that's where the good [ __ ] is

um national academy for social insurance

i don't know what that is spending

okay so kaiser family foundation that

too is

this kaiser

says two percent of operating

expenditures administrative costs are

closer to 17

[Music]

um

yeah interesting anyway if you guys want

good data like this is where you gotta

go

like you gotta go to cms.gov right go to

the primary source

um

so

those are the dlcs my friends a couple

of other

uh closing thoughts one is um

so just in terms of all the stuff that's

going on with like sexual assault and

and misbehavior uh we do have like a

a safe space for women on our discord

which i

recognize some people have issues with

and if we have it for women why don't we

have it for other communities and all

that good stuff like that's an important

discussion

um the short answer is that it seems

like women feel

get a lot of you know bad responses from

people

and so we do have a space for women to

feel free to like you know talk about

issues and

feel safe um you guys can check it out

on our discord i think go to the

announcement section and there's a way

to join

and uh yeah i mean so

um you know if you guys are are

struggling with with

any of that stuff and and you need a

place to go like that's one place that

you can go

i still sort of um so we recognize the

importance of that and

at the same time i think a big part of

our mission at healthy gamer is that

you know i personally believe that our

shared experiences at human being

as human beings trump at the end of the

day

any kind of gender or identity based

experience i think that

at the end of the day what brings us

together as human beings

is like greater than what separates us

is another way to put it

and at the same time i fully admit and

acknowledge that

you know depending on your race your

gender

or ethnicity or any number of other

factors

your experience of life is going to be

fundamentally different

um and so like you know balancing that

is tricky

and i think at the end of the day though

we're all just people and i'm

you know healthy gamer is here to

support people and sometimes some people

need more support than other people

so that's kind of how we work um thank

you guys very much for coming

um we've got a lot of exciting stuff

kind of coming out so

a couple of closing announcements so

we're going to have

um someone

yvonne from offline tv on wednesday

we have um austin who has like some

dating shows and stuff

on twitch on friday uh we're our

coaching program is live and is going

well

thankfully so i think people are getting

helped and stuff like that we're going

to be opening up

new spots um i think today

and then some more spots maybe one more

week from now where we may be

kind of full after that but go ahead and

sign up for the waiting list

we also started training our next batch

of coaches actually today so we had our

first coach training a couple hours ago

and so we're going to try to train them

over the next couple of months it does

take time because we want to make sure

that you know they're

able to do their good job a good job and

we have sort of

a pretty hectic training schedule where

they work with people

and we sort of supervise their coaching

and make sure that they can do a good

job so it takes a couple of months to

train them

about three months four months um

and yeah and i think the last thing that

uh is that we're working on

sort of you know more different kinds of

content

kind of stuff like this but we probably

won't necessarily stream at all but like

we want to do like kind of more

comprehensive content

so we're kind of working on all that

stuff and we appreciate all the support

um last couple of thoughts is you know

we i get a lot of requests from parents

and um give me just one

you