Stuff You Should Know - Rumors, Myths and Truths Behind Obama's Health Care Plan

Episode Date: September 29, 2009

In this third episode of Stuff You Should Know's health care reform series, Josh and Chuck -- and special guest Molly Edmonds -- sort through the myths, rumors and truths behind President Obama's proposed health care plan. Learn more about your ad-choices at https://www.iheartpodcastnetwork.comSee omnystudio.com/listener for privacy information.

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amount of ink. You can finally kiss expensive ink cartridges goodbye. Yeah, so check out the Epson Eco Tank. Just fill and chill available at participating retailers and at epson.com. Brought to you by the reinvented 2012 Camry. It's ready. Are you? Welcome to Stuff You Should Know from HowStuffWorks.com Hey and welcome to the podcast.

I'm Josh Clark. With me is always is Charles W. Bryant. And with Charles W. Bryant and I is our colleague and healthcare reform guru, Molly Edmonds. I think it would be and me, Josh. I knew she was going to say that. Yeah. Saw that coming. Yeah.

Well, she's not the first person to do that. You can send an email to StuffPodcast at HowStuffWorks.com Yeah, send an email, Molly. Thank you. I'm here to keep you on track on all things grammatical and healthcare reform related. And healthcare reform. Anything else? Yeah, that's good. That's it for now.

That's enough, right? Perfect. So for those of you just joining us, you should probably go back and listen to the first two podcasts that we released in this special Stuff You Should Know healthcare reform suite. And this is number three of four. Yes. We talked about what's wrong with healthcare in the U.S. in the first one, right? A lot.

We talked about Obama's proposal, just straight up facts. And then this one, we're going to talk about myths. Yes. Both from the left and the right. So, you know, those of you who are Bill O'Reilly fans, you can sit down and have a mug of beer with people who are fans of NPR, say. Right. If you're libertarian, you're just sorry.

You're out. Just go do whatever it is you guys do. Nice chuck. So let's get started, kids. You want to? Yes. One of the things that people keep maybe weekly throwing out is that the U.S. can't really afford to tackle healthcare reform right now.

Myth. Right? Is that a myth? Are we doing that? Should we have some sort of ding? These are all myths, actually. Molly says it's a myth and I agree with her. Well, you know, the thing about it is, is you may not be able to afford like a new TV,

right? Right. But if you had an old TV and it was a tremendously bad value, I mean, if you were just paying way more for that TV than it was worth. Like had to get it repaired a lot and that kind of thing. Yeah. I mean, then you've got to do something about it because you're just, you're not getting a good deal on your TV.

Sometimes it's smarter to buy the new TV. Yeah. And that is the position we are in right now with healthcare reform is we pay way too much money and get way too little care for, for what we have. So just if you like a good deal, I think you should be behind healthcare reform. So let's, let's recap real quick. The U.S. is spending about $2.4 trillion a year on healthcare that makes up a sixth of the gross domestic product and that's more than we spend on defense, right?

At the same time, we're not getting as much value out of it. So they say. Right. But we are entrenched in two wars and the economies in the toilet. You're saying still we should do something about it now. How are we going to pay for it? That's another, that's another common criticism we keep hearing is how, how are we going to pay for this?

Well, I think the specifics still need to be worked out, but I think that it's important to remember that the president has pledged that it will be deficit neutral. It's not going to add a penny to the deficit in the 10 year, the first 10 years that it is in action, nor after that. So, you know, it's, it's something that we could possibly say is a myth just because we don't know exactly how we'll pay for it, but. One thing. Taking with a grain of salt.

Yeah. I like your point you made in here that the people are afraid that the uninsured are going or the, I'm sorry, the insured are going to be paying for the uninsured. That already happens. Oh yeah. It's an estimate that families are paying about a thousand more in their premiums just because people who are uninsured still show up and go to the hospital. Yeah.

And they get treated. And an individual pays about 400 more. And so doctors and hospitals likely shift those costs to us because I mean, they got to get paid for it somehow and they know insurance companies will pay. So let's, let's flesh that out a little more. Say an uninsured worker, a day laborer gets hurt on the job, the boss comes and drops them off at the ER. The ER by federal mandate has to treat that man, stabilize him, fix his wound, whatever,

right? But he walks away. He doesn't pay. He doesn't have any insurance and possibly he's here illegally say. So what you're saying is the hospitals will end up charging more for patients that have insurance. They'll charge the insurance companies more and then the insurance companies turn around and charge more for people who have insurance.

They charge more in premiums, right? And then that's the way that there's a tax, an invisible tax for the uninsured that covers the uninsured that's in place right now. Right. That's, that's the thinking by the thinking that came up with these numbers that we are already paying for people who show up without insurance. And so if these people then had insurance, if this plan works and we can get everyone insured, then that would kind of cease that.

We're hoping that it will control the cost a little bit. Yeah. That would be great. So this is a $1 trillion proposal over 10 years, right? So clearly just making sure everyone has insurance in and of itself is going to be very expensive, right? Is it a myth then that there won't be higher taxes for people who say make a quarter of a million dollars or more a year?

I think that it's impossible to say what we'll actually have in place, but that is the president's current preference is that we tax people who make more than $250,000 a year. And then I notice a point that the president and people like Nancy Pelosi have made is that those people had been getting a lot of breaks over the previous eight years. What? And so they think that this is going to sort of balance that out without getting too political about it. But that's what's being said.

Sure. Yeah. Chuck can't help himself. They're going to start about libertarians. Nancy Pelosi said not me. So guys, let's lighten the mood a little bit. Let's talk about death panels. Yeah, let's bring a little comedy into this one.

This is probably the most pervasive myth, I would say, about healthcare reform. And arguably the most asinine, wouldn't you say? I don't know. I think if you are told that you might be put to death, you're going to take it pretty seriously. Yeah, you will take it seriously, but I'm saying the, I guess the thought process behind that interpretation of the House bill about end of life counseling. That's what it's about.

Right? Yeah. It says Medicaid or Medicare can be reimbursed for voluntary end of life counseling, right? It doesn't say anything about the patient signing a resuscitation order or do not resuscitate order or anything like that. It has nothing to do with actually terminating a patient's life, right? Right. That's the way they made it sound though.

Like they would stick the pin in grandma's hand and like put it on the line and if she just falls asleep and it scratches across. Sure. And all of a sudden there's a do not resuscitate order and one less old person we have to worry about getting an organ transplant for because she voluntarily said, I don't want it. It is a myth. And not only is it a myth, it is a career ruin or two. If you speak out too much, you guys heard about Betsy McCoy.

Yeah. John Stuart, the lady he killed. He eviscerated her. Yeah. Have you seen that Molly? Yes. She's the one that came up with the term death panel, right? Am I wrong there?

Yeah. I believe she's just the one. If she didn't coin it, she gets credit for coining it. She was so vociferous about it, right? So you know what? Here's the thing. Without pointing fingers at who came up with it, right? No one wants to die, right?

I would say most people don't want to die and they also probably don't want to spend a lot of time thinking about how they're going to die. And so the fact that we're even bringing this conversation up just makes it uncomfortable for some people. Right. The fact of the matter is that we probably all have in our head that we'd like to die maybe peacefully at home. And the fact of the matter is now, most people die in a hospital or a nursing facility.

You've said 80%, whereas 86% would prefer not to die there, yet 80% aren't dying there. So what we're trying to do is to respect, well, I shouldn't say we, like it's not me trying to do this, but what these bills are trying to do is to make sure that if you do have a wish about how you die or who makes the decisions at that time when you maybe can't speak for yourself, that those wishes are respected. The AARP has come out in support of this because the fact of the matter is is that even if we don't like to talk about it, it's going to happen. Let's have the conversation and if you have the conversation, have it paid for by Medicaid

and Medicare. Right. But you don't have to have the conversation if you don't want to. Yeah. It's completely voluntary and even if you have it, you're not going to leave that meeting with a living will necessarily or a DNR order, you're going to leave just knowing what your options are. Right.

I said I wasn't going to put my opinion in, but that sounds like a really good idea to me. Sure it is. Stuart pointed out in the interview that you can just as easily come out of it with a resuscitated any cost order. So it's not just specifically about DNR. Why they call it death panel? They should have called it life no matter what panel.

Because the death panel scares the tar out of the elderly. I know that's exactly right. I think that was one of the most odious things that come out of this healthcare reform debate was the death panel. It was specifically geared to scare the elderly. But they already have enough things to worry about. I think that some of the elderly's fears about this bill are founded when you hear there's going to be cuts to Medicare and that there might be incidences of euthanasia, which this

is not true. The death panel thing not true, but there will be cuts to Medicare. You can't get around that. Right. Sure. Let's talk about that because that's something that you raise in this article that it won't affect Medicare as a myth, right? It's a promise that the president has made in terms of benefits that if you are a Medicare

recipient that you will still have the same benefits that you've always had. Right. The fact of the matter is a large part of the funding for these proposals will likely come from Medicare because the way that Medicare operates now is probably unsustainable. So by making these cuts and incentivizing doctors to be more efficient in the way they treat patients. We're talking about bundling services, right? Bundling service.

So actually we spoke, Chuck and I spoke to Dr. Michael Royzen, who's the chief wellness officer at the Cleveland Clinic in appropriately enough Cleveland, Ohio. And he's also the co-author of the You the Owners Manual book series. And he talked about bundling services and it's based around what's called accountable organizations. It's like a group that's in charge of the health of an individual patient, right? Here's what he had to say about that. So I like accountable organizations, meaning that someone pays, if you will, whether it's

myself or the Cleveland Clinic where I work pays for my health care and I don't have to worry about it and they get a set amount of money whether I need 16 tooth extractions and four, if you will, revisions or four total hips, two total hips, two total knees, or whether I need none. And the goal of them, of those organizations would be then to keep me healthy so that I don't need any major technology procedures, teach me how to brush my teeth and floss so I need no teeth extractions, right? So that's what I mean by pay for accountable outcomes.

So if you couldn't tell, Dr. Royzen's very hip on prevention rather than preventative care. You're right, and he's also on board with accountable organizations. And he's also evidently on board with tooth extraction. He is. It's a good example. 16 teeth. Well, I mean, anybody can approach a tooth extraction, right?

But the point is, there has to be a group that is in charge of the health care of the individual, right? And then that way you can hold that group accountable. You're paying that group and you say, keep this person well and if they do need treatment, this is your pool of money that you have to extract from it, right? Like so many teeth. And here's the problem. And this is where I think a lot of the fear comes about is what happens when that money

runs out? Can doctors be trusted to say, we're going to still keep treating you or are they going to try to skinch on that? And I mean, is that a real fear? I think it's valid. You know, we would like to think that doctors become much more efficient. There's evidence that there is a lot of waste in the Medicare system. And ideally how this will work is doctors will say, yes, we will become more efficient

with this pool of money we have, but, you know, you just never know what case is going to come up that you can't treat a person with that pool of money with. So Molly, you just brought up another point is rationing health care, right? That's another huge fear among, you know, not just the elderly, but anybody. Like if this bundling of payments goes beyond just Medicare and it becomes a standard, I guess one of the ways it would become a standard would be to have some sort of panel that approves medical procedures, right? Right.

And there are some panels in these bills, but they do not approve medical procedures. Let's talk about those. These cost effectiveness panels are just meant to come in and decide which treatments are effective. There's no evidence that they would come in and say, you can only do this because it's cheap. It might be helpful to compare really quickly how Britain rations health care. Let's do it.

Okay. So they've got this committee called Ironically Enough Nice. That stands for National Institute of Health and Clinical Excellence. And then they're under the NHS, which is their big public system. So let's say that there's a drug that costs $15,000 and it's going to improve your standard of life from a 0.5 to a 0.7. They look at everyone's standard of life from a zero to a one. And it's worth saying that everyone's quality of life is considered important, whether you're

a 77-year-old woman or a 12-year-old boy. So it's going to improve your standard of life from 0.5 to 0.7, 0.2, and it's going to help you live 15 years longer. Okay. That's been proven in a study. So 0.2 times 15 is three. So they get a multiplier. And then, so that's what they call three qualities, quality-adjusted life year.

So they're saying your quality of life has been adjusted for these three years. It's like a multiplier. So then they're going to divide the total cost of the drug, buy the multiplier, and get a cost per year amount. In this case, if the drug is $15,000 and your quality is three, the drug costs $5,000 a year, and that's the number on which the nice would approve or not approve the drug. And nice basically approves anything, basically anything that's about $45,000 a year or below. So it's...

Are we going to base our system on that? No, that's not in the bill. Oh, okay. When people talk about rationing healthcare, Britain says, yes, we have rationed healthcare, and that's how they do it. And there's nothing like that in any of these proposals. Let's talk some more about, actually, before we do that, I want to bring up another point that worries me.

And that is that these panels that approve medical procedures could lead to a stifling of innovation, right? Is that a possibility? Well, I don't think so, because if you look, I mean, even if you talk about Britain, it's not like Britain's way behind us on medical innovation. It's in some countries, they've been able to do a lot more with a lot less. So isn't that sort of the true definition of innovation? I think so.

I think you basically have to prove that it works. I mean, we may not allow people to say, this pill will take you to Mars, if it won't. But what if they said, this pill is dynamite, would they have to prove that? Well, do they mean dynamite-like explosive or just dynamite-like awesome? Awesome. Okay. I mean, they definitely want to prove something that was explosive, in my opinion. Right, yeah, sure.

But I'm no doctor. But I'm no doctor. Right? Yeah. Than the FDA. Yeah. So I think it's just, you know, making people prove the quality. One of the problems so far is that we have a lot of care that we don't necessarily know

if it works, but it's really expensive. Right. And this is just ensuring that people have to prove that it works. Instead of spending all this money on marketing, their drugs, drug companies might have to spend more money on research and development, which I think we can argue would benefit a patient more than marketing. Sure. Boy, last time I was in the doctor, the pharmaceutical people came through there.

Have you ever been to the doctor on the app? Did they walk in and go, we got some dynamite pills? I know, well, who knows what happened behind the doors, but there were literally like seven of them. They were spaced out like every five or 10 minutes and they came walking in with their suitcase that you know was just full of drugs. Yeah. And they went in the back and then they came out and then the next dude would go in.

Sure. And then the doctor finally comes out after the last one leaves and there's little reflectors all skewed. He's like, next. Dr. Feelgood. Yeah. So is that how it goes down, Molly? Is that a myth or a truth?

You know, I'm not, I don't want to comment on Dr. Feelgood's personal life. Yeah. I think it's a whole different thing, but I think it's important entirely, isn't it? Big Pharma hasn't been made a part of this almost at all. It's not a part of healthcare reform. Well, this might be a way to make them more accountable. Right. Is these panels that will evaluate cost effectiveness of treatments, but let's reemphasize again

that these panels are not designed to say to you, you can't have this drug. Right. It's just saying we think this drug is the most cost effective. Why don't you try that before trying one that is more experimental, may not work as well, so on and so forth. It's not designed to get between a doctor and a patient. Okay. Good.

And I guess the last point that I keep hearing about rationing healthcare, it's very delicate, but there's a lot of people who say, you know, we kind of need to ration healthcare. You pointed out that healthcare is already rationed by the health insurance companies, right? Right. They have annual limits or lifetime maximums for care and by denying coverage to people with pre-existing conditions. But I think this whole idea that we may need ration care is kind of based on an idea that

the average patient abuses this healthcare infrastructure, right? That there's so much available and we have so little conception of value to actually what we're taking advantage of that we'll say, no, no, I want the MRI and that kind of thing. I think we touched on that in the first one, didn't we? And I think that's fair for both sides to say the patient probably wants more care and more care because we have a lot of people who know what's out there for them to take advantage of.

And then I'm sure you also touched on that doctors are paid for every service they provide to a patient. And so there's incentives on both sides for doctors. Just keep sending the patient in for the same thing, even if it's not working. Exactly. Because it makes you feel better. So Medicare with this bundling is going to be sort of the testing ground for trying to do this within our system as a whole.

That's the ideal. I don't know how it will shake out in the end. So can you say definitively whether rationing healthcare is number one, a myth or a truth that it's going to happen? Well, if we take Britain's definition of what rationed healthcare is in terms of a panel making a choice whether you can or cannot have this drug, then no, there's nothing in these bills that would do that. Whether eventually there would be fewer services and fewer of these people going in and getting

every single service they ask for, then it's possible that might decrease. But that could be a good thing. It could. It could be. And ultimately you can make the point that this is very similar to government prohibitions on drug use or something. You have to be a certain age to buy tobacco or to buy alcohol. That's pretty much arbitrary.

This is actually a little more focused saying, no, we have this huge infrastructure. You guys are costing us $2.4 trillion a year, a lot of it unnecessary. So you could argue the point that maybe somebody does need to step in and say, you can't do this because that's stupid. That's true. But then on the other hand, you've got someone who takes nine tests and the 10th one would have been the one that worked. And if they feel in any way that they didn't get that 10th test because of they already

got nine, then that's where people start to get worried. Is there any mechanism to sue the pants off of the person who denied you that 10th test? Well, currently we've got the whole medical malpractice thing. Right. But if it wasn't a physician, if it was a government panel or something like that. Oh, could you sue the government? Yeah. Hmm.

Could get very hinky. Some of the decisions that the NICE panel makes are controversial. They deny a lot of really expensive cancer treatments and as a result, Britain has worse cancer survival rates than the US does. Whether someone has tried to sue, I don't think so. Because you can pay in England, right? Our colleague Lee Dempsey pointed out yesterday that you can actually pay for better care. That was awful.

What was that? Everyone, I just want to apologize to Lee for Chuck's terrible, terrible impression of his British accent. He's actually not from England. He's from a small island that's not been yet named. Minoa? And they have a very odd accent there. So guys, I don't know a good way to put this.

Let's talk about abortion. Is it a myth? That's a great icebreaker, by the way, for your next dinner party, Josh. I'm having deja vu. You should keep that in your crawl. You know, that's how a lot of episodes of Stuff Mom Never Told You start out, if anyone's interested. Chris and I just go, let's talk about abortion.

Really? So we highly recommend you go listen to that podcast. But women's issues. It's a big thing. Obviously, people who want women to have the right to an abortion would like to see abortion be a necessary benefit included by the government. What these bills provide is the government to come in and say, these are things that insurance plans have to cover to be considered valid insurance plans.

Right. So there's a big debate about a lot of things that be covered, like mental health. How much will that be covered? Abortion is the big one that is dicey because no anti-abortion person wants to pay for someone else's abortion. So how the house is compromised on this is that health providers can choose whether to provide it. It doesn't necessarily have to be one of these essential benefits, but it can be.

And if you do get an abortion, the thinking is that you would pay, not with these public subsidies that are available to people, but you'd have to pay out of pocket for that unless it was one of the abortions that's defined as, you know, in the gray zone, the rape sort of abortions. Right. I saw the Senate Finance Committee bill as it stands now prohibits funding, except in cases of rape, incest, or endangerment to the woman's life. Right.

And that's, I mean, that's the bill that, I mean, that's the plan that a lot of like Congress people, for example, have. Right. The government currently pays for abortions under those qualifications. And also the Finance Committee bill, which was just released yesterday, but you said it's not the final version, right? It's his mark. So it'll still go through the Senate Finance Committee.

Okay. It's the chairman's mark. On abortion, they continue to say that the bill would prevent abortion coverage from being included in a minimum benefits package and in the health insurance exchanges where you shop for the coverage, but the plans in exchange could include, they could offer abortion coverage as long as no government subsidies pay for it. Instead, the coverage would be funded through member payments, which are segregated from the federal money.

Right. So that's what the Finance Committee says. Yeah. So that's consistent with how the House had it as well. Is it? And basically the thinking is that any given area, you should be able to choose one plan that has abortion covered and one plan that doesn't. But they would be, I saw this in your article too, they would be the same plan except one

covers abortion and one doesn't. Right. Okay. But it's, everything else is the same. Yeah. It's the same price I imagine. I would think so. Yeah.

What? For the total plan? The total bill? If you're in the marketplace, those insurance marketplaces we were talking about, you should have a choice of a plan that has abortion and a choice of a plan at that time. So you'd have like a premium abortion pro plus and then that's premium, no abortion plus plans right next to each other and they should be the same, the same cost just to give people a choice.

Right. I'll tell you about the total bill. No, no, no. The Senate finance bill is about $150 billion cheaper. Do you remember how when we went into the marketplace and we were looking at all those insurance there? Yeah. Yeah.

I get it now. Okay. So you can be pro choice choice. Yes. You can have the choice to have the plan that has the choice. You just blew my mind. Wow. My mind is melting all over the table.

All right. Guys, can we talk about something that President Obama loves to say it's usually the first thing he kicks off with. If you like your insurance plan, you can keep that plan. Yes. Molly Edmond says that is not necessarily true if you start looking down the road and read between the lines, right? You know, the thing is, is when Obama went out this summer and did his town halls, I

think that if he had a nickel for every time he told people that if you like your plan, you can keep it, he would have enough to fund healthcare reform. But I think if you were paying attention to the speech, he made the famous speech to Congress. You will notice that that phrase did not appear in the speech because I think he's realized that he can't promise people that their plan will stay exactly the same under these reforms. We're saying you can keep it though, not necessarily that it would be the exact same plan that you're keeping.

Well, but that was how he was sort of pitching it, is if you like your doctor, you can have your doctor, and the fact of the matter is, is that your plan is going to change already to build in these consumer protections. So that's a great change. You know, you won't be able to be dropped by insurance company, they can't discriminate for pre-existing conditions. And then your plan will have about five years probably to come up to speed with all these other plans that will be grandfathered into that minimum set of benefits we were talking

about. But you know, in that marketplace when they start competing for all these uninsured customers, we don't know what current plans will have to do to stay financially viable. They may have to slash services. They may have to slash services. That kind of stuff happens anyway though. Your insurance plan probably isn't the same today as it was five years ago without all this government competition.

That's true. And the thing is, if you don't know how your plans change over the five years, you may not notice how your plan changes when this happens to you. Right. Yeah. Well, first of all, I didn't have insurance five years ago, but I couldn't tell you what it looked like last year. Right.

You know? You were living in the mountains. I was living in my car. Okay. I mean, the only way you're going to know is if you go to the doctor and all of a sudden they don't accept your insurance or if something that used to be covered isn't covered anymore. But that's just so speculative right now that it's impossible to say one way or the other, whether, you know, things will be the same or not.

I think a lot of this from what I'm reading is like the outlines in place, but who knows how this is going to shake out. Sometimes you have to wonder if we have to believe the best about people or the worst about people. Well, I think what it comes down to, I keep running across, you mentioned that this whole thing is a Rorschach test or the public option is a Rorschach test and really what it comes down to is, can you trust doctors to not skinch on healthcare when they're being paid in bundles?

Right. Is that a word? Skinch? Skinch, yeah. Okay. Yeah. If it's not, it is not, pal. You said it twice.

It's just that the government panels won't, you know, stifle innovation. Right. It does come out. Undercut the insurance company so much where they can't stay in business. Sure. Can you trust Obama that this isn't really a plan to ultimately create a single payer system? Right.

And can you trust individuals to take it upon themselves to, like Dr. Royzen is a big advocate of, to take on preventative care? Yeah. You know? The burden for health is on the patient as much as the doctor. Right. And I don't think that mindset is clear to a bunch of Americans. No.

But that's what they're using as an excuse. I mean, someone who would be against a big public option or really subsidized healthcare would say, this person got themselves into this mess because they smoked or they're overweight or so on. And so looking at just what the mistakes a one person made is like not seeing the forest for the trees. So all these pieces are working together in a way that we can't isolate blame at anyone. But that's what this discussion has turned into saying that, you know, the worst is

going to happen about these people. Agreed. And when we spoke to Royzen, if I can bring him back again, he said that apparently basically us not caring at all about our health is costing this country more than any other sector of the healthcare, of healthcare spending. He put it like this. 75% of all healthcare costs are caused by chronic disease that is caused by four factors. Tobacco, food choices and portion size, physical inactivity and stress.

So we can reinvigorate primary care by paying physicians to teach these things because what gets paid for gets done and what gets done gets taught well. So in fact, we have a tremendous opportunity of paying physicians to do this and saving a huge amount of money. In fact, if all we do is a program, and I'll go to the exact bill, it's called S1640, Take Back Your Health, that does this for five diseases, coronary artery disease, type 2 diabetes, metabolic syndrome, breast cancer and prostate cancer, we save after paying for it, we save $1.9 trillion over 10 years.

So clearly, as Royzen pointed out, Molly, you are right. In very large part comes down to us changing our perception about our own health and taking responsibility for it, right? Let's do one last one. You guys mind since we're not doing listener mail? Let's do it, Josh. Are we moving towards a socialized country? This one?

No. Well, do you know the definition of a socialized country? Chuck, go. I do not. Josh, go. It's a state-owned and operated industry. That's right. Yeah.

So not only is the government paying your bills, they're hiring your doctors and running your hospitals. Right, right. So that's what Britain does. And then there's also fear of a single-payer system, which, you know, Obama has a few choice quotes that people like to pull up saying that he would like a single-payer system. Right. That's what Canada has, where all the bills just go straight to the government, no questions

asked. In Taiwan, right? Doesn't Taiwan? Actually, let's say that, because we're going to talk about healthcare systems from around the world in the next one. You know, most countries have some form of single-payer, but whether we've been promised a uniquely American system, because we are a uniquely American country. It's probably too late at this point, don't you think?

Even if we wanted to switch to socialized medicine, we couldn't do it now. I think you could over the course of several decades. Fifty, a hundred years maybe. But I, you know, we're certainly not there with these proposals. There's no need to fear these specific bills as any sort of move towards single-payer or socialized medicine. Well, I think one of the concerns, though, is that this public option will eventually run the other insurance companies out of business, and then we'll have a de facto single-payer

system, because the only man left standing will be the public option, right? Is that one of the fears, the concerns? That is a concern. The public option is so in the air right now that it would be hard for us to make any sort of conclusion about whether that's a myth or not, you know, the thing that just came out this week, the Senate Finance Committee one that's going to get all marked up, that went for co-ops. So, you know, how will a co-op work in this system versus what would a public plan be?

So that right now is such a shadowy thing that I think we should avoid speculating on it. Okay. Agreed. Agreed. No, we don't want to stir up any more fears. The whole point of this podcast was to allay them pretty much, right, or at least say, no, you're right.

You should be scared out of your mind. Here's my guess. Do you think they could do anything to put every insurance company out of business? No. That's what I think. Yeah. I think the one out of all these... I'm on record.

Call me in 10 years. If there are no more private insurance companies in America, then I'll buy you a beer. Really? Yeah. Anyone out there, I hurt you. Yeah. Of course, I'll be dead in 10 years. Yeah, you will be.

Because they'll have rationed your healthcare. Exactly. You face the death panel. I know. No, I want to live. But you sign. Sorry. Guys, that's about it, right?

Got any more myths you want to cover? Oh, I know one. Uh-oh. Illegal immigrants. Yeah. Oh, you thought you were getting away without talking about this, huh? No, this is a big one. As I saw, actually, in the House bill, it basically says, actually, it does say, if you're born

in the United States and you're not covered, you're automatically covered. Does that amount to covering illegal immigrants? Now, not necessarily the people who are that same day laborer who went into the ER, right? Right. We're not talking about him, necessarily, but the children of illegal immigrants would be covered under that language, right? Right. So, I mean, that is technically correct that illegal immigrants would be covered?

Well, no. Their children will be covered. Right. But they themselves, the children, would be considered illegal. No, they would. No. If you're born on American soil, you're an American... Excellent point.

There's no... I mean, it's not... There's no law that says that, but it's generally thought that if you're born on American soil, you're an American citizen. Okay. So, technically, they wouldn't cover illegal immigrants. Does it in any other way? Well, the way it was explained to me is that illegal immigrants would not be able to receive

any sort of subsidies because there'd be too much need for proof about where they were born and where they... All their paperwork would have to be in order to get these subsidies. Right. But it's possible they would be able to enter the exchange and buy insurance because they would be, you know, subject... I mean, there's nothing that would keep them out of the marketplace per se. If they want to pay, then welcome to the game.

Yeah. Well, but some people aren't ready to say welcome to the game. Right. Molly, I am looking forward to your second career as a diplomat. I know, seriously. Thank you again for coming in, and we'll see you next time when we cover another one of your articles, which is healthcare systems around the world and how they compare to the U.S.

Dr. Royzen is going to be back. Yes. So, we'll Chuck's goatee. We'll talk about different countries. People are already emailing saying, what about us in Canada and England and in Norway? Yeah. Yeah. Chuck's been responding with pipe down.

We're going to get to you, all right? Yeah. If you're looking for a place to move, I think that that podcast will be really helpful. Okay. In the meantime, you can basically take advantage of Molly Edmond's giant sponge-like brain and learn everything you need to know about healthcare reform by typing healthcare reform in the handy search bar at howstuffworks.com. And by the way, if you want to send us an email praising us, condemning us, telling

us that we're in favor of illegal immigration, whatever, just send it to stuffpodcast at howstuffworks.com. For more on this and thousands of other topics, visit howstuffworks.com. Want more howstuffworks? Check out our blogs on the howstuffworks.com homepage. Brought to you by the reinvented 2012 Camry. It's ready. Are you?

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