Armchair Expert with Dax Shepard - Flightless Bird: Healthcare

Episode Date: August 9, 2022

This week on Flightless Bird, David sets out to make sense of the very confusing American healthcare system. Joined by Monica, he tries to figure out why some Americans end up paying their own ambulance bill and why over half of the American population is riddled with medical debt. David talks to Luke O’Neil - the journalist and writer behind the popular newsletter "Welcome to Hellworld" - about why it falls on children to raise money for their parent's medical bills and discovers why in the US healthcare system teeth are considered “luxury bones”. Learn more about your ad choices. Visit podcastchoices.com/adchoices

I'm David Farrier, a New Zealander who ended up accidentally marooned in America, and I want to grasp what makes this country tick. LA is not built for walking. I've never been more aware of my own mortality than when strolling here in the City of Angels. I mean, there are places that don't even have a sidewalk. You just walk along the road, praying you don't get hit by a car. At every crosswalk, an angry line of cars threatens to run me down. And looking death in the face got me thinking. It got me thinking about

the cost of my life, the cost of keeping my life and keeping my body intact. It got me thinking about the American health care system. A recent survey finds Americans have collectively borrowed about $88 billion to cover doctor and hospital bills, bills that can be confusing or even come as a shock. The system here terrifies me. See, in New Zealand, it's a user-pay system. Our taxes go towards free health care for all. But here in the US, over half of Americans have medical debt. A quarter owe 10 grand or more in medical bills. So while around 300 million Americans have health insurance, 30 million don't. And sometimes having health insurance doesn't help all that much. This is crazy to me, and I want to find out why. So look both ways and pray you don't get hit by a car or maybe a train.

This is the healthcare episode. Flightless, flightless, flightless bird touchdown in America. I'm a flightless bird touchdown in America. I'm a flightless bird touchdown in America. It is something that I've been thinking about since I got here because I do feel very fragile and I do worry that if I ever end up in hospital, it'll be over for me, you know? You are fragile because you don't even put the A in front of hospital. You think it's just hospital.

It's just hospital. Yeah, it's just hospital. It's just hospital. Yeah. It's deep, this topic. It's heavy. You picked a hard one. I've had a lot of different kinds of insurance already in my 34 years. Yeah, right. I had under my parents, obviously.

That's the best kind. That's great. I had that in New Zealand. It was wonderful. Yeah. It's just all sorted. What age does that turn off in New Zealand? I actually don't even know.

It's just at some point I started paying for it myself. I think the second I left home, it was like, we're done. You do have to pay. For private insurance. So I come from a very privileged family that has private health insurance. The interesting thing is that we've got a public health care system. So if I break my leg, it can all get taken care of for free. But some procedures you just get done better if it's private. But at the same time,

some are better public than private. So there'll be people in New Zealand with private health insurance that still use the public system for some things because it is better. I already have a gajillion thoughts on this. So, yeah, I was under my parents. And then at 26, I believe, children get kicked off their parents' insurance. I got on Obamacare. Right. It was pretty expensive for me, which was interesting. Uh-huh.

Because I was very healthy and young. So it should be cheap. It should be the opposite. Because nothing's going to happen to you. Exactly. But because Obamacare, I'm also kind of paying for other people who have entered into the system too, who need a little bit more support. Yeah, some people need more support than you.

Exactly. So weirdly, I ended up paying more on that than I feel like I should have. Right. Then I got on SAG insurance. We've covered this recently on Armchair Expert as well. Because it all depends so much on whether you have an employer or not, or whether you're a freelancer or where you are in the system. Exactly.

Yeah. So if you're freelance, you have to kind of go get your own. And if not, then you can be under your employer's insurance. Right. But here there's this big, do we move into free health care for everyone? But why can't we do what you guys do where there's also private offerings? I don't understand why we can't have both. No, I mean, it's something I get into in the documentary in this episode a bit.

But this idea of free health care for all and your taxes paying for other people's health seems like america doesn't really get on board with that it's more about like personal responsibility for ourselves yeah and that's just such a different attitude to new zealand i guess i mean the thing i'm mainly confused about i wrote this down this morning because i'm trying to figure out what health insurance to get because at the moment i don't have any because you're a freelance yeah and i'm a new zealander i'm like what do i even get here it's because at the moment I don't have any. Because you're a freelance. Yeah. And I'm a New Zealander. I'm like, what do I even get here? It's like at the moment, I'm paying for health insurance in New Zealand and I don't even live there at the moment. I should cancel that. But a question for you, it's so obvious, but what's the difference between HMO

and PPO? Because HMO is cheaper. HMOs are cheaper. You have to go to their doctors. Okay. So it's like a specific list. Exactly. got to go to this doctor this dentist this whatever david you have to get a ppo okay so if i'm on an hmo it's cheaper but if i get like hit by a car and i'm in an ambulance am i meant to sort of be like looking through my like that's outrageous i know not this one because not only am i hideously injured but i'm gonna have to owe a million dollars well this is a great question i don't think in a hospital system it's like that okay because that's what i was imagining if you have to go to the doctor for anything and you can plan it you can't go to just any doctor that you look up they have prescribed doctors and you can only go to them.

And in my experience, they suck. I have an HMO. When Natalie was pregnant with Vincent, I had to get a blood test. And I had to go to like six different clinics to find more. I remember you telling me about this nightmare, Rob. That's because of HMO. Yeah, so I need PPO. Rob and I both need PPO.

Yeah, I feel bad saying that because there are definitely a lot of people, obviously Rob included, listening who have HMOs, and they probably feel the brunt of the system potentially more than people who are under PPO. It seems ridiculous that there's two systems. It just feels like here's your cheap one, here's your expensive one. The cheap one is utterly useless to you because you can only go to like one doctor and he's going to probably be kind of useless for what you need specifically.

He might be a great doctor, but not for what you need at that point. All the options are not open to you. Yeah. I think part of it though is if you go to the doctor a lot. Like I barely ever go to the doctor, so that's why we pick the cheap one. You can do a high deductible PPO. Yeah. Yes, there are plenty of issues with our healthcare system,

and there are, and we will talk about them, I'm sure. But it is one of the best places for healthcare in the world. You're right. The procedures themselves, the medicine, the innovation. CRISPR was invented here, all the vaccines. America is innovating incredibly well in the medical field. And if you've got the money, America can be a good place to get the procedure that you want. Probably the best if you can afford it, yeah.

Yeah, right. Or if you have access to really good insurance, which here in LA, we have union insurance if you're a member of SAG or the Writers Guild or Directors Guild or whatever. And they're incredible. They're incredible. I can't believe it. So I need to get onto those. I need to start acting or something. Okay. Yeah, but you have to make $15,000 a year to keep it. Okay. And then that gets tricky. It's like every year you might not be eligible. So that part is a little scary. It's all the rules that get me. Sure, that innovation's amazing here, but if I personally can't access it, I'm like, what's the point? Sure, that innovation's amazing here, but if I personally can't access it, I'm like, what's the point? Like, who even cares? David, you should be in

the Director's Guild. So much of America I don't understand. It's like, I need to figure this out. Okay, that's for a union episode, I guess. Okay, this is for a specific episode, unions. Because I do get lost in all this. And so I went out, as I always did, and just talked to a bunch of people I met on the street about, or in case a park what they thought of the health care system and yes some people loved it some people less so some people confused the American health care system I find it incredibly confusing can you make any sense of it yourself no it's so confusing I work for myself as a massage therapist, and to have health insurance cost up to $850 a month,

and I'm completely healthy. It sucks. And period. It sucks unless you are super rich or a member of government, then you kind of have to, like like work just to pay for insurance. Healthcare I think is a right that should not be tied to whether or not you're able to get a job with someone who can offer you the benefits that you need. Even if you are employed, if you're like a service industry worker, it's likely that

you don't get healthcare through work. So then you have to do like navigate the free marketplace for healthcare on your own and there's not a lot of guidance. When I was in college, there were no psychiatrists in the area so there was a program that would ship the medication that I needed to me at school which is awesome, it was covered by my insurance and halfway through college, I get a letter from my insurance company that says we've partnered with CVS and therefore you can only get your medication from CVS which means I can no longer use my psychiatrist back home and I have to find a new one where I go to school. And then I got to

prove to them I actually need this stuff. It's not personal, but it feels personal. I was married to someone who had a liver transplant and insurance then paid the $140,000 that it cost to get a new liver. And we were very satisfied with the care. Oh, that's great. That's great when it works out. I hate health insurance. I'm a nurse, so being the person who provides the care, I don't understand why there's this third party who's charging these extravagant means of it,

and it's not even going to the people who are actually taking care of the people. So that really frustrates me. I also spoke to a lot of people that day who were just so incredibly confused i couldn't even use in the segment because they were just kind of like as i was talking to them they were trying to figure out like the whole system and it made me feel more secure that even a lot of americans don't understand like what the hell is going on you know it's almost like they make it complicated on purpose just like finance like i feel like stocks and stuff they make it all complicated on purpose so that you don't really

look into it yeah i read a stat americans spend 2.8 trillion dollars on health care annually this was on vox that works out to about one-sixth of the total economy more than any other country if the health care system were to break off from the US and become its own economy, it would be the fifth largest in the world. Oh, wow. So the whole system here is... A major industry. It's a major industry. Yeah. So look, just keeping it simple, have you ever had any

healthcare where you've been panicking internally about, will it be covered? Or have you had like any health insurance disasters because when i got strep throat i thought i had covid again i had strep and it was like really sore so i was holding out and going to a doctor because i don't want to go to a doctor i've got no insurance what do i do and so i ended up going to i paid a hundred dollars and it was in hollywood urgent care urgent care and there were some characters in there that was fun i had like quite a long way and a lot of drunk people in there it was wild actually but i got really good care he gave me a test that was extra so i was like oh no how much is the test going to be that was an extra like 15 i said i definitely want the test yeah she came back she'd you've got strep gave me some some pills, brilliant. How much were the pills?

The pills were, I think, like another $20 from the chemist. The visit was $100. The strep test was another $15. So it wasn't that bad. But my point is I was really worried going in there. I don't know what this is going to cost. I don't know what's going on. That's the only time I've been to a doctor in America ever.

I've got a lot of New Zealand friends that live in America. They don't have any insurance. If anything bad happens, they just fly back to New Zealand. Yes, everyone will get treated here, but then you'll be paying for the rest of your life for that treatment. Yeah, or you've got to sort of run and avoid the bills as they start piling in the door kind of thing or flee back to New Zealand. So some people I'm sure might do that or they don't and then they're paying for the rest of their life. It's nice to know that you'll survive. America will take you to a hospital and will patch you up

and sew your leg back on. They'll never turn you away. We have a friend who tore up her whole knee and money is an issue. She has insurance, but it's not covering everything, obviously. And it's a lot. And she's not covering everything, obviously. And it's a lot. And she's not going to file bankruptcy. But it's a stress. But it's a stress. It's a stress now that they have to pay for that for a while.

I know I come from New Zealand. We've only got 6 million people to look after. It's so much simpler. But in New Zealand, if something happens to you, you'll get treated and you won't have to pay for it kind of thing just the worry here i think for me is always like what will the bill be stay tuned for more flightless bird we'll be right back after a word from our sponsors flightless bird is brought to you by athletic greens i use athletic greens ag1 every day because I eat like a disgusting child. You don't eat well. I eat sugar and cheeseburgers.

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Framebridge.com promo code BIRD. This whole thing is so confusing to me. I went and talked to someone that knows way more than I do about this. He writes purely about the healthcare system. So I thought I would tap into his dark little mind. I'm very aware that healthcare is a very political topic here in America. I remember being in New Zealand watching glowing news reports about Obamacare over a decade ago. But you know, Mr. President, you've done what generations of not just ordinary, but great men and women have attempted to do. But Mr. President, they fell

short. You have turned, Mr. President, the right of every American to have access into decent health care into reality for the first time in American history. That clapping didn't last, and it faded as criticisms of Obamacare became rife and new voices rose into power. Tonight I am also calling on this Congress to repeal and replace Obamacare. If it's one thing the ongoing health care debate in America proves, it's that both the right and the left love to clap and share and yell. It's all very American. But in all that sharing and yelling is another emotion one Luke O'Neill knows all too well. Misery is making for great company these days. Luke writes a newsletter about America called Welcome to Hellworld, documenting a lot

of America's darker side. Luke grew up in the punk scene and he brings that attitude into his writing. Luke grew up in the punk scene and he brings that attitude into his writing. And he's been writing for over 20 years. Vice, Slate, Esquire, and his own thing, Hellworld. It's at Hellworld he writes a lot about the American healthcare system. It's quirks, it's oddities, it's triumphs, and everything else. You know, you've been reporting for a couple of decades now for a variety of publications. That's right, yeah.

Bird's eye view, is healthcare in America getting better or worse? I know that's a really probably naive question, but I honestly don't know. It may have gotten somewhat better in a very small way, but if you look at how hard it is to make any ground and to improve anything and how slow things are moving, it's hard to even feel good about any of the small gains that might have been made. Here's the thing. I don't have health insurance here. And I've been stuck in America going on 10 months now. I'm lucky enough to have travel insurance. Unluckily, it doesn't come cheap.

So I'm thinking about health insurance in a very practical way like i probably need it right i'm on a travel insurance plan at the moment and i need to figure out what health care plan to get on how does it work here well here's an analogy it kind of explains how health care in america works okay so imagine you go into a restaurant the waiter arrives and tells you what you're going to be having for dinner. And you say, well, wait, can I look at the menu? But no, there is no menu. So you say, well, can you give me a general idea what this is going to cost me? No, no, the waiter doesn't know.

The prices will be figured out later after you've eaten. And in any case, neither the waiter nor the chef, they don't have any idea what it's going to cost anyway. It's some other guy who's going to determine what it costs. Some guy unrelated to the restaurant. And so you say, okay, well, I guess I need to eat. So you order the steak. Then a couple months later, you get a bill. And on the bill, it charges you for every single aspect of the preparation. It says $5 for the salt you used, $2 for the butter, $9,000 for the meat.

And then if you have a complaint about the prices, you can't go back to the restaurant or the doctor that actually saw you. You have to go to the insurance company. They're the people that are setting the prices. And the inherent conflict there is we think of a doctor as this person that is supposed to care for us, right? By and large, they do a good job of taking care of the problem. But then anything related to cost is out of their hands. And so now we're left to appeal to these giant corporations, these handful of massive insurance companies. Their goals are the exact opposite of a doctor.

They don't give a shit about us. So at that point, we're just out of luck. And you're stuck with massive bills for something you didn't choose. Starters, sprained foot, entree, broken leg, dessert, cancer. We're screwed at the end of it, you know? So if I don't have an insurance policy of some kind in the United States and I need to see a doctor or I need to go to an emergency room, I'm kind of fucked, right? Yes. Now, you will be seen if you go to the emergency room, but what you're going to be charged, depending on the severity of what happened, could be from just the hundreds ranging into the thousands of dollars. And now, let's say you have to stay overnight.

That's what starts to really add up. It can be like tens of thousands of dollars. And now, let's say you have to stay overnight, that's what starts to really add up. It can be like tens of thousands of dollars a day. Hospitals in America are more expensive than the most luxurious, expensive hotel rooms anywhere in the world. And the food sucks, too. I'd like a hotel room, please, with an extra large bed, a TV,

and one of those little refrigerators you have to open with a key. Credit card? You got it. I just did this big piece where I collected a few dozen stories of people talking about how shocked they were, whether it was Scotland or Japan or wherever. They hurt themselves, they showed up to the doctor, they got taken care of, no bill, no paperwork to fill out.

Most of the people here literally do not know how bad we have it and at the same time very loudly proclaim USA number one. USA! USA! USA! Luke's documented the healthcare experience all across the globe. A $4 doctor's appointment in South Korea, a mountain biking accident in South Africa leading to an ER and private hospital at a grand cost of $125. A CT scan in Denmark for $0. Is the thinking here that you just have to get health insurance and pay your $200 or $300 or

however much it is a month, just like you pay for car insurance, and that's fine. Is that kind of the thinking? Well, a few years back, Obama, with the Affordable Care Act, required people to get health insurance. And if you don't, there's penalties and taxes and things like that. But still, many people either forgo that because they just can't afford it in the first place, or they just sort of roll the dice and be like, well, I'm young and relatively healthy. When I was in my 20s, I didn't have health insurance because I couldn't afford it. It's basically like rolling the dice every time you step out onto the street or get in the car.

Some people get insurance through their jobs, but people who have lower paying jobs don't always get this perk. So the people already in the worst possible position to not be able to afford to pay for hospital bills are the ones that don't get insurance through work. But even if you do have health insurance, nothing is guaranteed, which is a real bummer. So you can have health insurance, but let's say you fall down, you're out at the bar or something,

you maybe had a few too many, and next thing you know, the ambulance is here. So many stories I've heard from people who have had to fight their way out of the ambulance or like beg people, please do not put me in the ambulance. Because even if you're insured, there's no telling if that ambulance that shows up is going to take you to a hospital that takes your insurance or you might end up getting a twelve hundred dollar bill just for riding two miles in the ambulance. So the fact that we even have insurance doesn't even protect us. And that's why so many people were disillusioned with Obama's Affordable Care Act, because people just saw it as forcing us to have to enrich the insurance companies while barely even getting anything of quality in return. Something happens to you, you just have no idea where it's going to go financially. I'm sorry that this isn't a very light-hearted conversation.

I did an interview with a woman who has epilepsy and she has an awful lot of seizures. And she's gotten to the point where she's told her close friends, if I'm having a seizure, do this and that, but do not call 911. So she has to worry about whether or not she's even going to wake up in the first place. But even worse than that is figuring out what the bill is going to be for her having passed out. bill's going to be for her having passed out. My real simulation father has so many thoughts on the American health care system. All right. Is he similar to Luke or is he more positive? He thinks that we have too much care here. I think he really ultimately thinks the Affordable Care Act and Obamacare was the right thing, needed tweaks, of course. It was government and the private sector. And the problem that people didn't like

about that was then there were limitations, right? Like you could only go to the doctor three times a year. You get one physical for free, but that's it. You get blood work once a year for free, but that's it. You're right. And people are so different and their needs are so different. Some people would need blood work like 10 times. Well, my dad would say no. My dad would say they don't. It's an impractical thing to offer. Why are we paying for this?

Exactly. Like what? You don't really need to go to the doctor six times a year, but some people do. Some people have an issue and they have to go all the time, but most people don't. Most people do not need to go to the doctor more than once a year. And that should be covered in your physical. It's also preventative care because you're getting everything looked at. You're getting your blood work done. He would say part of the problem with the system is that we believe we need access to healthcare at all times, and we don't really.

You're right. And I imagine there's a certain part of the population that we're spending most of our money on. A lot of people don't need that system. There's going to be a small portion of America that is using up most of those resources. And so there's that weird imbalance there. And they need those resources, but on the rest of us, it's difficult. And he would say, we can shift it a little bit. Let's have more telehealth, where if you have your strep throat, you just go onto the internet. In five minutes, you get a prescription for that. You'll be smart with this thing.

Exactly. And instead of going to the doctor and paying this, a lot of things can be treated much easier. And actually, I had a telehealth with the strep. It actually didn't go my favor because they were like, we don't think you've got strep. It'll just be like a sore throat. That telehealth ended up being wrong.

But I did really like that existed yeah because we as far as i know unless it's happened since i've left we don't have that in new zealand yeah and that's brilliant because you don't always need to go into a room and sit with someone you almost never no almost never right like you really it's this huge trick just to be like i've got this just write me a prescription for this thing exactly so there's so many different sides to this. The thing I find incredible as well is that doctors, they're paid by procedure. That's a really strange concept to me. Which is why there is some overcare. Maybe what they could do in three treatments, they do in six.

Because why not? And the fact that insurers get to have so much of a say in the costings of things, it just seems so utterly strange to me. Of course, everything's going to get insanely expensive. Stay tuned for more Flightless Bird. We'll be right back after a word from our sponsors. Flightless Bird is brought to you by Masterclass. Now with Masterclass,

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masterclass.com slash bird for 15% off every masterclass. So yeah, back to the documentary and Luke O'Neill. And I had a question about one of the newsletters he wrote for Howlworld. You had this incredible line in that story. We're supposed to get used to all the death. After your first few calls, they say it becomes a lot easier. That's sort of an analogy about how we become inured to the suffering here. When it happens to somebody you know, you probably get outraged, but it happens so often every day to so many people here

that you just kind of have to become numb to it, or else you lose your mind. Reminds me of a clip I saw on The Daily Show last year. Comedian Ronnie Chang was talking about how in Singapore, people who'd refused to get vaccinated and who'd ended up in hospital were being made to pay their own medical bills. It all sounded so American. And this is how that discussion went.

Where do you draw the line? It's a sticky situation. Yeah, but in Singapore, Trevor, I don't think people realize Singapore is saying that if you don't take the COVID vaccine, you have to pay for your COVID treatment, which is a huge deal in Singapore because Singapore essentially has universal health care. So for them to come out and say,

you are going to pay for your own stuff if you don't take the COVID vaccine, we're going to treat you like an American. That's a punishment in Singapore? In Singapore, being treated like an American in the healthcare system is the biggest punishment you could give someone. And sometimes here in America,

I do feel like I'm losing my mind. Even the way things are reported here. I've lost count of the number of stories I've heard of cute kids doing a fundraiser for a sick parent or dying sibling. And it's all reported like it's this inspiring, beautiful thing. I feel like lemonade stands are no longer just about kids raising money for themselves. I mean, we've been talking about these all summer and they're just so inspiring. Karis Quinn is using her lemonade stand to raise money for Mediviver.

It's an organization that raises money for stage four breast cancer. So our goal is trying to get a million dollars, which is actually supposed to be a thousand. She is so cute. And her lemonade stand is just so creative. I love it. Cute and creative aren't the words that spring to mind for me. It's such a grim spectacle.

It's like, you know how in films and TV shows, Squid Game is the latest example. We have like these dystopian game shows, you know, and we watch them and we're like, oh my God, what would it be like

to live in a reality like that where life is so cheap? But how it works here, GoFundMe, which is a major crowdfunding site, is basically a lot of people's health insurance plan. I always joke that there's no real benefit having a social media presence, but at least by having a pretty big following, I know that I'll have a lot of people that'll chip in if I ever get cancer. That's my insurance. Somebody's got some rare disease and ends up

going viral. Some celebrity might see it and they'll share it and it'll raise all the money. And meanwhile, there's these thousands of other ones that just go unfunded and these people are just have to go fuck themselves. You know, it's like when you get sick, you need to hope that it catches the eye of a big influencer or you do it in like a sensational way or some sort of unique way. You know, it's got to be new. It can't be something that people are sick of. It's like little boy with leukemia. I already heard that story.

You know, can you give me something a little punchier? You know, something that can really get me to open up the wallet. It's such an incredibly cynical way to look at it. And I think that being cynical is sometimes the easy way out. But on this one, I'm with Luke. Go viral or die trying. It's hard not to be cynical about that. There was a time when I was on Kickstarter a lot

and I'd see a creative project that I liked and I would like giving money to that thing. Here's $20 to someone who's got an incredible film idea or they want to market something and make something. I don't really do that anymore because I do see on my feed and people looping me in with causes because this little kid will die if they don't get money. It's insane. Another really sad dystopian element to all of this is CNN had a big story about a little boy, I think he was 13. He was a Make-A-Wish recipient. And this young boy, and you know, God bless him, he's a sweet kid. What he wanted to do was use his final wish on helping to feed the homeless in his city. So we have

stories like that happen. And then the news shares them like as if they're these feel good stories, like, oh, what a kind boy. And everyone comments like, no, look at this kid. This is what we need more of. This is how we used to be in America, helping each other. These stories go viral all the time because it makes people feel good. But the subtext is it's a fucking nightmare. Like what a horrible story

that some Girl Scout has to sell cookies and lemonade to make $800 to chip into her mom's $75,000 hospital bill. So I don't know. So many of us are just willfully turning away from the reality of what's going on here. It's hard not to think about the healthcare system in other countries like, well, New Zealand. Everyone chipping in to help somebody who isn't them.

Right, exactly. Isn't that the logical next step of these GoFundMes? But you see, we can't do that here because that would be socialism. And that's very bad in America, not just to the right, but to the centrist Democrats and the mainstream liberals. Because even though we're paying these taxes, it's considered somehow weakness to then want to get something out of it on the other side here. I don't know, is that something you're aware of? Or is that boggling your mind?

Oh, it boggles my mind completely. I mean, I'm fascinated by this, because in my mind, so many Americans out there that are voting will have had terrible run-ins with insurance companies and will have ill health and will have horror stories. So surely enough of the voting population and enough Americans would see that taxing people would go towards health care. What's the dissonance there? America as an idea, there really is this rugged individual thing that still persists throughout our culture. It's very easy for people here to remove their own circumstances from the collective public and from the collective goods. So it's like, when something bad happens to me, well, this needs to be figured out right away. This is an outrage. But if something bad happens to somebody else,

it's like, well, what did they do? Did they have it coming in a way? Like, were they making bad choices that I certainly wouldn't make? They must have done something wrong. I wonder if this fear of communism and healthcare sort of short circuits people's brains so they can't ever look at the common good. I mean, people have tried. Medicare for All was introduced as a bill back in 2003. In 2017, Bernie Sanders introduced a parallel bill. But none of that has come to pass. What does America have? Well, there is Medicare, which means a part of celebrating a 65th birthday is also celebrating the fact you can finally get free federal health care, which has its upsides. A thing that happens, and this is why nationalized health insurance is good

in the first place, is that when you have a single payer like the United States government, they can negotiate prices from a much stronger bargaining position than if everything is fractured. So to get an MRI here that costs $2,000, whatever, to go in there, that's what the hospital and the insurance companies are going to agree to charge. The government can say, no, we'll pay you $200 for that. And so the end result is it's going to be $200 for the MRI, not $2,000. So that's what Medicare does. And they do this with drug prices and things like that. Then there's Medicaid for those who have fallen through the cracks, whose income drops below a certain point, or who might have a disability of some kind.

There are about 72 million Americans on Medicaid. The threshold for getting it changes state to state because while some of it is funded at a federal level, individual states also chip in, up to half sometimes. Counties chip in too. So in Texas, you've got to be earning under $25,503 to qualify. That drops in California, we've got to be earning under $16,395. That's nothing. You can hardly thrive on that amount of money. Obviously, that's a very low level of income, but slightly above that, and even tens of thousand dollars more than that, still puts you in no position to be able to pay for any of these costs, you know? So it's good in theory that it's

there, but there's so many people that have fallen through the cracks here. Yeah, that threshold is so, so low. Right. So all of these things we have in place, it's like we've got a little bit of protection for the poorest people. We've got a little bit of protection for the oldest people. But everyone else is sort of walking on the trapeze wire the whole time, hoping we don't end up in huge debt. The other thing I find quite weird about healthcare in America, from the Affordable Care Act to Medicare to Medicaid, are the bits of your body not covered, even if you do miraculously end up with some kind of cover.

Like your teeth and your eyes and your ears aren't considered part of the body technically in America. Those are all separate things. Those are not covered by medical insurance. Those are like luxury senses. You know, people always call teeth luxury bones here and getting into dentistry is a whole other thing. Luxury bones. I really, really like that expression. And it's definitely what I'll be calling my teeth from now on. But yeah, even Medicare doesn't guarantee help with your teeth. And when you're in your 60s, that's probably when your teeth could use some help. But no, 65% of people on Medicare don't receive dental coverage. Luxury bones. If you have a tooth problem and you have medical insurance, it has nothing to do with your teeth. So if you get a failing or you need a root canal or

something like that, and you've got really great health insurance, then you're still gonna be on the hook for a hefty bill. And people told me their dental care nightmare stories, going for years, suffering with an abscessed tooth or needing a root canal and just constantly being in pain because dental work is so expensive. And I've been through this myself. Again, I don't think I went to the dentist for my entire 20s.

And I ended up needing a couple of root canals, which cost me like $4,000 a tooth. And you couple that with the fact that all of our dentists are being bought up by corporate chains now and they're being pressured into doing as much work as they can. So you go into the dentist and you can't even trust whether or not they're telling you the things that you need are true or not or if it's something you could maybe get away with for another couple years and doesn't need to happen right now but they're just trying to generate some work for themselves you know yeah it's like when you have a current and you take it in to the mechanic and you don't fucking know what they're telling you is true or not right and so again not just with teeth but for our bodies in general the american healthcare

system damages your thinking not just the public health we talk ourselves out of going to the doctor and we put things off and then what happens is when you don't stay on top of things much like with the car you're talking about like if you get something rattling in your car and you don't stay on top of things, much like with the car you're talking about, like if you get something rattling in your car and you can't afford to fix it, you just let it go. And next thing you know, now you need all this work done on it. Same thing happens with our bodies. You know, you've got a little lingering cough. And if you went to the doctor, they could have caught it. And you just go without and it turns into this full blown thing.

And so there was a study is that a lot of people were being diagnosed with cancer at exactly age 65. And can you imagine why that would be? Yeah. Hello, Medicare kicking in. Right. So bleak. Let's say you're 63 and you're starting to feel like shit, you're going to go, okay, well, I'm going to wait a couple years and wait until it's paid for rather than going to the doctor right away. If you could catch cancer six months earlier, nevermind three or four or five years earlier, it's going to be a much better health outcome. It's all about catching it. Exactly. And this study that I wrote about is it show that this significant spike in a number of different type of cancers that exactly age 65. And I think that, if anything else, is one of the more depressing anecdotes about the American health care system I can think of.

Do you have any sense of any shit together? Or is my time in America just going to be spent in constant panic that I'm going to get horribly injured and become bankrupt? Even though every single story here I told was absolutely bleak and depressing and demoralizing, believe it or not, for people who are listening here, I try to imbue my writing with a sense of hope and a sense of possibility that things can change. And I do believe that they can. It's going to be a real steep hill that we have to climb. And the way to do that is by recognizing our shared humanity and our shared concerns. So we're very divided in America right now, but it's mostly by cultural things taking our eye off the ball of what we all have

in common. And that's that we all have human bodies. We all need healthcare. We all need to see the doctor and see the dentist. And even though I'm a little bit demoralized today on the day that we're talking, I have to believe that we can come together and recognize that. It is kind of fascinating, the luxury bones portion. Oh, I hadn't even thought about that. I love that term, but the fact your teeth are not, and ears, that's a specialty thing. And I'm sure there's some historical precedent for that, but to have those as separate things. I mean, it's got me thinking now, like, oh God, I don't have my medical insurance sorted, but what about my teeth?

Your dental, yeah. I'm getting a gap in one of my teeth that's growing and i actually sometimes whistle accidentally if i get excited and i'm talking i'll sometimes just let out this whistle yeah it's a problem but i'll just be talking in a group of people and there'll be this big like this big toot and everyone's like what's that and i like i used to get like i went bright red the first time it happened and everyone's like is that you that? And I used to get, I went bright red the first time it happened. And everyone's like, is that you, Dave? And I'm like, yeah, it's this fucking gap that's just opened up. So my point is, I'm 39. My teeth are on the move for some reason at this age. I thought this stopped as an adult. Pimples stop, your teeth are in place. But apparently that's something that happens to adults, their teeth move. What am I going to do about that over here? How much is that going to cost me? Oh man, that really made my day. I'm a podcaster now. I can't be whistling at random times and I'm excited. I can't believe you're letting out random tooth farts. I want to hear one. I do have a hack for you. You could go to UCLA's dental school and you kind of have

to wait there all day, but they'll help you. Get a fresh student. They'll help you. Yeah. Right. You get a little cheaper treatment. That's a great tip. Also, what's not covered, which is unfortunate, and this I would not say is a luxury bone or orifice. Luxury bit of the bod.

Your brain. Mental health. Like therapy is not covered often. Totally. Talk about getting upstream on issues. Exactly. Mental health is like a huge thing, right? Yes. If you're going to get therapy here, what do you need to do? Is there any free or cheap? Well, better health is an affordable option. Yeah. A good therapist is between $200

and like $500 or something, right? An hour. And also had therapy in new zealand and it's not an hour they cut you off mine's 50 minutes yeah that's some bullshit what are they doing admin before the next patient that should be an hour that you pay for not 50 i love my therapist so i don't want to say anything negative but i mean at that 50 minutes all right they start to wrap it up you're like hey it's not midday yeah It's 10 to when she gives me some extra time. I feel like I'm special and also that my problems are really bad. Yeah. Like stretch her.

Yeah. Huge cost. Not covered. Yeah. I would love to see that be incorporated into more. Yeah. I mean, even in New Zealand, our mental health system is a mess. I mean, we've got one of the highest youth suicide rates in the world.

Just because I think we're isolated and socially, we've got some weird things going on. To get a therapist, you've got to go to a doctor. They might refer you to someone, but you're not going to necessarily be able to get in. Also, drugs are really expensive here. Oh, God. Pharmaceuticals is another entire thing. Vox had this piece again. I quoted from them before.

There's some heartburn medication. In the USA, it's $215. It's $23 in the Netherlands. Really? I don't even have the capacity to talk about this. I don't understand these prices and how it surges. It seems bonkers. It was like Martin Tsiolky, whatever his name was, right?

He bought that pill and suddenly it was up to like $2,000 a pill as opposed to like being $2. He was like America's villain for a while. He bought this pharmaceutical company and just did crazy things with him. Everyone hates him. Well, it's also tricky here because, and I'm sure this is everywhere, but then once there are generic pills of the prescription, then it's cheaper. I'm on this birth control that has a generic, but I can't take that generic. It makes me feel crazy.

And so I was like, I need to be on the real deal, but it won't be covered. So now I pay $130 a month for this. That's crazy. Just for a birth control that works for you, that doesn't make you want to like puke all the time. Yeah. That's outrageous. But I mean, they have a ton of different kinds so look like i could eventually you could find one maybe work for you yeah yeah but what a process i know exactly really

not something you want to like mess around with too much yeah one thing we didn't even talk on it a big issue is that people's insurance starts skyrocketing once they start having issues. And people can't get on a different insurance because they have prior conditions. They can't get it. That stuff, Obamacare also got rid of, which I really appreciated. But I guess it's gone. I've sort of tuned out of the American. I don't even know, to be honest, what's going on right now with our current president. That clip at the beginning, Obama will do a thing

or Trump will come in, something more different. I don't know what Biden's doing, but it's like, we don't have a chance to get a trajectory on anything. It's like, new president gets in, it's just like yanking the old one. It's like nothing gets a chance to actually have runway. No traction. I know. That's a i know that just seems kind of odd a generalized problem with our polarized system right now so the main thing i've learned i feel like i haven't learned a lot from this i feel like i'm more confused and down about the whole thing but i just know i need ppo instead of hmo yep i would prefer that for you yes okay and we're gonna get rob and his beautiful family to jump onto a ppo system as well. I'm going to get on a

PPO system because I'm lucky enough to be able to be able to do that. I do feel worried for all the Americans that are sort of slipping between the cracks. It seems problematic. So there's this big argument that Luke brought up that everyone wants to look after themselves and doesn't want to pay for the rest of America's problems. But if a third of the country's already on Medicare and Medicaid, and that's kind of a system that's working, and we've all kind of accepted that, there is an argument to be made, you'd think, where it's like, no, let's just expand that to the entire population,

and we all just pay for that, and then I'm going to be covered as well if I want that cover. Brilliant. It's not like we're not doing a bit of user pays. Yeah're doing it for the certain part of the population. So why not expand it to everyone? It's not that much of a hard pill to swallow. Yeah. And giving everyone that option would be nice. But if I'm going to role play someone who is against it, I would say, why should I pay more in taxes? Why should I sacrifice my really, really good healthcare for more people who might not be contributing the same way I am? That's what they would say. I don't want to pay more for other people. It's just that thought that always gets in

the way. I wish I could just point to them and be like, it's already working for a third of the country. So let's just expand it out and say to those critics, no, you're already paying for like a third of America. You're already doing this. It's not that much of a stretch to just punch it out a bit bigger. I think they would say, I don't want to be. I'm already paying too much. Every time that number goes up, every time I go into a new tax bracket, I'm pissed. I get it. I don't like seeing that amount leave my paycheck either. I have to be understanding of someone who works really hard, gets their paycheck and sees a lot of it go and is thinking, this isn't fair. I work hard for this. And the more

that taxes get taken out, the more of that feeling. Most people do notice it. Most people notice that. Just for insurance to work, it's like we're all agreeing. There's like this social contract. It's like we're all in this together. We're all going to put some money in the kitty and we're all going to honor this and help each other out. The trouble is that there's those people that are just going to be living their lives being like, fuck that. I'm going to like get drunk every night at this bar because I want to. I don't give a shit and I'm going to fall over and hit my head. I'm going to be in the hospital. I'm going to drive recklessly. And those people are ignoring that social contract and they're going to cost the taxpayer in this hypothetical wonderful world

where we're paying for everyone like a lot of money. And those people kind of mess it up for the rest. Yeah. The taxpayer who works a 12 hour day looks at the other person who could care less about their health and is thinking, why should I be paying for that, looks at the other person who could care less about their health and is thinking, why should I be paying for that person? On the other hand, you have a lot of people who have these really terrible health problems that aren't their fault and they're going to cost the health system a lot of money. And there's also, I think, resentment towards those people

when there shouldn't be. And we're still going to pay for them regardless. If they can't pay and they go to the hospital, it's not that that charge just gets erased. The rest of us are going to pay for them regardless if they can't pay and they go to the hospital it's not that that charge just gets erased the rest of us are going to incur it still ultimately at some level coming out of our taxes because the federal government's going to someone has to pay for it you know it's going to get written off there and so we're still like we're paying for it no matter what so that why not make it simple and just oh yeah it's frustrating it's a generalized american problem are we here to help everyone or are we individualists?

Here to make it. And yeah, make it on our own when it's all about us and what you do. Yeah. And I think there's merit to both. I mean, I do have an opinion on what I pick, but I get both sides. I'm a pure socialist from New Zealand. And I just want us all to put a bit of money into the kitty and just help everybody out. I get it.

And it's going to be a utopia. Hey, well, look, we're a third of the way there. We just need to go a bit further. Well, you're not more American. Are you? You tell me. I mean, I think once I get my health insurance, I'll be a bit more American then. Until then, no change.

Great.