TRASHFUTURE - Same S***, Different Organ Farm feat. Tim Faust

Episode Date: April 2, 2019

This week, Riley (@raaleh), Milo (@Milo_Edwards), and Nate (@inthesedeserts) speak with health justice advocate and writer Tim Faust (@crulge) about his campaigning for single-payer in the US, why anything besides Medicare for All is a scam, and why the creeping privatisation of programmes like Medicare and Medicaid resemble Tony Blair’s ‘reforms’ of the NHS in the early 2000s. If you liked what Tim had to say, pre-order his book here! https://www.mhpbooks.com/books/health-justice-now/ During this episode, Riley references a Wired article about friend of the show Matt Hancock and his generous benefactor Babylon. You can read that here: https://www.wired.co.uk/article/babylon-health-nhs *LIVE SHOW ALERT* We'll be performing live at Bristol Transformed on Friday, April 5th at 8 pm. The venue is Hamilton House 3A, 80 Stokes Croft, Bristol BS1 3QY. https://www.facebook.com/events/814946762200366/ View the Facebook event page here: https://www.facebook.com/events/814946762200366/ *COMEDY KLAXON*: On April 10 at The Sekforde (34 Sekforde Street London EC1R 0HA), two of the most profoundly funny voices in British comedy (and members of the Balthasar Speedboat cast), Pierre Novellie and Alex Kealy, will perform at Smoke Comedy. The show starts at 8 pm; tickets are £5 and can be purchased here: https://www.eventbrite.co.uk/e/smoke-comedy-featuring-pierre-novellie-and-alex-kealy-tickets-58849486398?aff=erelexpmlt Also: you can commodify your dissent with a t-shirt from http://www.lilcomrade.com/, and what’s more, it’s mandatory if you want to be taken seriously. Do you want a mug to hold your soup? Perhaps you want one with the Trashfuture logo, which is available here: https://teespring.com/what-if-phone-cops#pid=659&cid=102968&sid=front

Hello, and welcome back to your free TF of the Week. How's everybody doing? Absolutely. Wonderful. Amazing. The sun came out in London, and I'm like, wow, maybe God hasn't forsaken us completely. But then I realized it's too warm for this time of year, and like S actually he has. Absolutely.

Yeah. A happy Brexit day one and all. Oh, yes. It's like Guy Fawkes night. It doesn't really mean anything. It's just like you can go out, light off some fireworks, you know, Mark Francois probably out and about dressed up in camouflage, I don't know, like shooting blanks, immigrants or something.

It's a great day to be British. What I like most about it, of course, is that the official Vote Leave pro-Brexit rally and the official Tommy Robinson pro-Brexit rally, wouldn't you know it, they ding-dang mixed up, and now they're all one rally. Oh, no. They were supposed to be separate because one's, you know, totally not racist, and then the other one is a classical liberal, actually. But wouldn't you know it, the marches just blended in together.

Was it like the classic, like being on two dates with the same girl? Like there was one person who was like supposed to be on both marches, and he kept having to change from his like a George Cross t-shirt into his like tweed jacket and back again. Oh, hi, Jinx. Because I think there's no, anytime we talk about Brexit on this show, we always have to then leave space for Nate to say how Brexit's gone. So Nate, what's happened in the last couple of days? Well, the deal keeps failing and the indicative votes seem to indicate nothing because we

can't agree on anything or we can't disagree on anything. Maybe we want everything and nothing, it's 2016 forever, and we live in hell. And what should we do about it? Given that polls show labor pretty high up, I say have a general election. Wow. Always fun and informative to hear about. Well, the independent group apparently got really sensitive about the fact that they're not a political party and decided that they're going to declare themselves a political party

and their new name is going to be Change UK, what they didn't realize is that acronym is C-U-K or C-H-U-K. So either it's Chuck, Cuck, or Suck. And if they win one seat and then hold it in an election, it would be Cuck, hold. But we're not talking about that today because we did our one Brexit episode and that was our one Brexit episode. We did it with Tom Cabbasi. Go listen to it.

That's all we really have to say on the matter. What we're talking about today is much more healthcare related. So there's the Vote Leave talking about funding the NHS. We're actually talking about funding the NHS. And we are joined by America's Tim Faust. Tim, how are you doing? Howdy, lads. Thank you for having me.

Good. Better now that I talk to you. You're going to talk about all the fun in healthcare on my side and your side of the big ocean. Oh, yeah. Tim's read the trash future manual that says that a great start to a podcast is to flirt with the hosts. That's right.

Yeah, absolutely. So you may know Tim from his work in the United States on promoting a concept that you talk about that you refer to as health justice, which is one that I find very useful when you're talking about not just access to care, but just how healthy people actually are. It's the Dr. Bronner's all-one soap of health policy. The idea that all these things are interconnected and interrelated, a big lattice kind of lashed upon us. And that, therefore, they're all worth considering as part of a broader taxonomy of what healthcare

is and what healthcare can and should be. I'm currently on the Dr. Utker health plan, which is where you just eat frozen pizza. That's food. Food's healthcare. You're reading healthcare. No problem. Exactly. It's self-care, baby.

Awoo. Yeah, scented candles is a crucial part of health justice. Just taking some time for yourself, that's health justice. Cutting your nan out of your life because she criticizes you that you better believe that's health justice. Yeah. I'm just speaking to her. I usually lead with crystals and candles.

That's kind of my main, I wrote a book that's coming out soon and really about one-third of it is about health finance and two-thirds on crystals and candles and eating ice cream every day. So that's kind of my angle. 100%. Oh, yeah. It's actually interesting, most healthcare, most beds in American hospitals here are actually going to be replaced with soothing bubble baths.

Love that. Yeah, if you've got like late-stage renal disease, all you need is some foam to feel better. Take it away. Just walking onto the intensive care ward. Get that negativity and toxicness out of your life. It doesn't matter if it's your kidneys, no, it doesn't matter. It's all mindset.

Going to medical school and your only textbook is The Secret is an extremely interesting concept to me. Sauntering onto the transplant ward going, let's get these bitches moist. Racious. So we can say that private healthcare systems, shockingly to anyone who's heard this podcast, which is famously pro-market, that marketized healthcare systems don't really deliver what you might call health justice, except in the form of like an app or a crystal or a book about how to shit better.

Available from all good bookstores. So, Tim, I think we might want to start with you sort of going into some of the basics around marketized and privatized healthcare. Sure. So there's healthcare and there's health finance. Here in the U.S., most of our healthcare, actual healthcare is self-privatized. We've got private hospitals, Catholic hospitals are a big deal here because they don't provide things like trans healthcare, reproductive healthcare.

Any hospital with a saint in it or any hospital that's privately run is considered private healthcare. We do have that's relatively new where we're ahead of the curve is in the privatization in the finance of healthcare. There's this idea that I think we built together, Thatcher and Reagan in the 80s, that the government should spend money not on providing services, but the government should funnel all of its money into private companies that should provide the same services at cost and worse somehow. They did it, that public programs are inherently wasteful or inefficient.

It's this big cycle that I know y'all have talked about in which you take a public program and you starve it of funds and then it does bad and then you punish it for doing bad by taking away more funds and giving them to private companies who then do that same work of less well and only for profit and therefore like most people get served. You see it happen in transportation with Uber and Lyft. You see it happen in policing. You see it happen in prisons. We should have prisons, but we certainly shouldn't have private prisons and you see it in healthcare.

In the UK, I know you guys do have private hospitals that are just for people who pay with private dollars. In the US, it's a little bit different, but now what we're seeing- Some are just for royalty. Oh, of course, because they need a special place to shit and do a bedpan. Absolutely. They do it better than the rest of us. A gilded bedpan.

I just love how much Reagan hates or did hate. He's not alive anymore. Hated public spending of any kind, unless that public spending was like, a laser that will destroy communism. Right, of course. You know the stuff we really need. And then when the so-called war is over, you can use it to provide laser eye surgery again. The huge eye doing laser eye surgery on Sauron.

Exactly. Look, I think you left these are out to freaking lunch, in my opinion, if you can't see value there. Whoa, whoa, better lock my Twitter account. Lazy from 10 miles away. Hell yeah. But that's clearly an ideology designed to funnel money into private companies and basically into the hands of rich people, right? God forbid we accidentally use money to take care of poor people and that money could instead

go into the hands of Richard Branson or whoever the fuck. That's the base of ideology. And so we're seeing that in health finance as well. We've got the privatization of Medicaid and the privatization of Medicare, which are two American public health insurance programs. And so I wanted to talk a little bit about what that kind of looks like and how it's happening and how that ties into the broader Medicare extra for all or other programs like that that we're seeing.

You know that when something's called Medicare extra, that that makes it better. Well, it's extra. Yeah, there's more of it. It's like we're not just going to give you, say like, a cast for your leg. What if we give you a whole body cast at no extra cost to you? It's not like those little Medicare's that you get in suburban areas. It's like the big out of town Medicare that you have to drive 40 minutes to get to. But you can buy things in much larger quantities.

God, I've got 15 kidneys for the price of 10. Why buy Pepsi when you buy Pepsi Max? I apply the same concept to my health. I mean, if bigger is necessarily better, just by definition, a larger. Why just be mad when you can be extremely mad? Trump said it. The Great Lakes are good because they're the deepest lakes. No one has deeper lakes than us.

When the Great Lakes should be proud of that, that's exactly why we need to apply the same logic to American health care. The Great Lakes should be bigger and more and more extreme and maybe have some exclamation points and be on a skateboard. The Great Lakes, they're very deep lakes. One of them once said to me, but what if we're the simulation? OK, you ever think about that? I'm trying to think of a segue, but I cancel this jump right back into it.

Yeah, I think this is this is Medicare. Don't let me distract you too. That's going to be very important. This episode, if you want to simulate a way to to provide health insurance, you've got Medicaid privatization in Iowa. So Medicaid is a health care program, health insurance program that's run by a combination of state and federal actors. So it varies state by state.

You've got a lot of different Medicaid programs, but fundamentally, it's not the kind of thing that you can make very profitable because Medicaid provides insurance to low income people who are often sicker and people with higher incomes because being poor makes you sick. Poverty is illness, but that's not going to stop us from trying. Iowa has entirely privatized their full Medicaid program. They have three things called MCOs, which are managed care organizations who the state pays and the federal government pays a lot of money to offer

insurance plans to people on Medicaid in Iowa. And so if you want to the core problem in insurance is that it's not profitable to ensure sick people because sick people go to the doctor and if they're even sicker, they go to the doctor more. And so therefore you've got to spend more money on them. But like you can't just tax them or you can't just charge them what they spend because they would go they would get broke. You've got to float it across the entire like risk pool.

But at Medicaid, you can't just jack up costs because you're limited by Medicaid. So what do you do? Well, you do a couple of things. One, you if you want to like increase your profits, you've got to reduce the amount of care that people get. You could do that in two ways. One is you can limit providers. You build these narrow networks if you're privatized Medicaid.

And you say, oh, only these doctors or only these hospitals are in network, right? The same thing you have in standard employer sponsored insurance. That's bad in Medicaid because not a lot of hospitals take Medicaid in the first place because it has lower reimbursement rates. So limiting the number of providers disproportionately harms patients with more needs or who live in rural areas and don't have a lot of doctors available to them and who therefore have fewer options and need to travel further and further to find care or need to like find childcare if they've

got a kid at home. And so you've got this idea of care coordination. They're going to limit this down to a number of smaller hospitals that they pay less will then cord it all your care. And so therefore privatized Medicaid restricts access to things like urgent care centers or minute clinics or the other kinds of like in this big like cheesecloth of American health care for poor people. This idea of like minute clinics have popped up like the places where you can

walk in, walk out, get treated for a small bruise, a scrape, a sore throat, pink eye, that kind of thing. And walk out. What? I mean, why? OK, I'm going to ask why is that funny? It's just pink eyes. Pink eyes. Funny. Come on. It's a funny disease. I mean, I still think people should be able to get it treated for free under

a socialized medicine program, but I think the doctor should be allowed to laugh at you a bit. You know, that's my position on pink eye. Although if you're not 13 and you get pink eye, you get laughed at. Yeah, I wanted to say like you see like the system you're describing. It's that they it's that we at some point the logic went, OK, we need to increase the provision of a service without charging more money for it. So what we're going to do is we know when we know that the public sector doesn't have private sector style incentives to like innovate or whatever.

And so we're going to give this we're going to basically give Medicaid to a private company so that they can innovate a solution. But they seem really to have only innovated ways to not give people anything. They're innovating ways to make a profit, which is limit the amount of insurance they pay out. So they limit the providers you can go to. Damn, again. It's incredible. It keeps happening. It's happened. This is some Lucy football ship.

This is like the five thousandth time this has happened. It keeps happening. This reminds me of the news item I read recently from Russia, where like some company that produces eggs realized that the cost of producing eggs due to like the current sanction situation in Russia had like increased by about 10 percent. But rather than increase the price of a box of eggs, they just reduced it from 10 eggs to nine. They have to make these special nine boxes.

That's good. I can love that country. So so carry on. And like these these urgent care clinics just fortunately treat a shift laborers, right, because either go to the ER, which costs a million dollars, or you go to the one clinic that's open because doctors are open. So a privatized Medicaid just doesn't cover. So the cost money. Sorry, I'm going to show my Canadian,

who's been living in Britishness for a while. I thought that the ER was supposed to be free, which is why people end up going there. No, the ER absolutely just hit you with a bill. It's in the 80s. They passed a law that they have to treat you, even if they hit you with a bill later. They have to stabilize you.

Yeah. Yeah. There was at one point a debate on whether or not they should treat you in the first place or just let you die because you couldn't pay. Am I? I'm not wrong on that to my hope. No, you're right. They have to stabilize you to treat you. So if you walk in with like a gunshot wound, they need to keep you from dying,

but they can transport you to another another ER that might take you in if you don't have insurance. So I'll give you my personal story. When I was in college, I was an ROTC cadet and I was playing basketball for our physical fitness training one morning. And my friend and I went up for a rebound and he elbowed me in the mouth and knocked one of my front teeth out. And everyone's reaction was like,

oh, fuck, you need to go to the hospital. But I mean, like, unfortunately, hospitals where I lived in Indiana, they weren't equipped to for like dental emergency stuff. So I got taken to a hospital like in my friend's car and got admitted, given a bracelet and then then handed a pamphlet on tooth decay like how to fight cavities. And they just gave me a gauze pad and then I got a bill in the mail the next week for four hundred and sixty five dollars.

And that was 10 years ago. It's probably way more now. And I wound up having to pay for it, even though like it's the equivalent of an A&E. But in Britain, you go to an A&E and you don't pay anything because you don't pay anything anywhere. Going to the ER actually costs more than making an episode of the 90s drama ER. Yeah. And as a follow up to that story,

when I went to an oral surgeon, once their office opened, they refused to treat me until I could produce proof of payment like like a credit card or something. But I would say dental is so fucked up in America that I don't want to like take the conversation on down a rabbit hole because like as fucked up as medical, the medical situation is in America, dental is even worse. That would be great.

Actually, if as a budget option for Medicaid, instead of going to the real ER, you could get treated for exactly half an hour by the cast of the 90s drama ER. They'll do their best. They have access to the equipment. They've experienced some generic medical information over the course of making the show. It's much cheaper than going to real doctors. Central casting via uninsurance. That's pretty good.

They're not very busy, you know. Oh, they got a lot of free time right now. They can take care of you. 100% right. So back to back to Iowa. Oh, yeah. So basically, like in an attempt to create profit, privatize Medicaid, reduces the number of providers you can see, reduces the amount of services you can get,

which means that if you have, again, the most needs or the most care, you need the most care in the first place, you have more and more obstacles between you and the care you actually need. You'll be shunted into a nursing home, which is also owned by the same company that provides your insurance in the first place instead of receiving long term care. If you need that's good, though, that's good, because you want them to work together and you want them to be experts on you. They were anything.

They're experts in the subject of you. That sounds great. Oh, just like the NSA. They they work together to like put you in a warehouse where you suffer and die. It's pretty chill. And they're really good. It's Amazon. This is this is a lot like, honestly, I'm going to go Warhammer 40,000 here.

But this is like, of course, you are in the Imperium. If you commit some kind of heresy, like if you say that the emperor isn't literally God, for example, one of the lighter punishments you can get is that they will treat that they'll treat everything wrong with you. Then they'll lobotomize you and replace your brain with them with part of a machine. And then they'll unbomb you. So you become a semi undead servitor that just exists to serve whatever like petty lord or inquisitor you happen to piss off.

So basically, I like hosting this podcast. So basically, America's Warhammer 40K minus the health here. I mean, yes, the God Emperor, if I recall correctly, is trapped in his body for all time, but can't really move or do anything or fall apart. And that's otherwise, obviously Donald Trump, otherwise, otherwise, hell will consume all of reality. Yes, damn, we'll have a 401k. I mean, that's when that's what nursing homes are in the US.

If you're a person with disabilities, you go to a nursing home, they keep you alive, maybe until eventually they fuck up and they kill you. And no one cares. And that's just that's just the brakes. That's what insurance covers, because insurance companies also often own nursing homes in the first place. So they're coordinated and care about giving you the profit. That's why the how could that go wrong?

I mean, the reality is people with disabilities don't matter. No one cares about them. So they speak up all the time and they fight for like things like Medicaid, Medicaid rights, but until recently, nobody really listened until they got militant. That's why ADAPT is a really cool organization if you hear about them. That's why Bernie Sanders, for example, including long term care in his and Jayapal, including long term care in her single payer bills is such a big step, because finally, like people who need these things are being listened

and even give you the chance to like write the policies that affect them. But like we're it's you want to you want to focus on some real hell, world shit, look at nursing homes. Anyway, back to the other hell world. Indeed. So you limit the number of care, you limit the kinds of care people can get, make it really, really hard to get care. You restrict where they can get care by limiting providers.

And at the end of the day, you get a profit of some sort. You just that's how that's how economy works. Right. And so, of course, we saw Iowa's per member cost for Medicaid triples since a privatization took place. And that's on the back of a lot of providers having to close because they're not getting funded through these programs. So just like that, you see in gapped Medicaid gap states, you're seeing like small rural hospitals close, rural providers get shut down.

And the Medicaid privatization companies got an 8.4 percent raise last year. At least someone did well out of it. Yeah. Yeah. Here's the I not to sort of look too far forward into the future of this episode, but I am already struck by all of the quite close parallels that we're going to be drawing between the US and UK. Like all the stuff I have prepared in the UK version after this, like all of the beats in the story are the same, essentially.

Like every single element is the same. It's just it's just whether you're it's it's it's that privatizing a public system. It seems to work in the same way. It starts at the same rhetoric and then it slides into the same just sort of downward spiral of everything fucking up because it was never meant to be a private service in the first place. But privatizing health care is a lot like jazz. It's really the space between the hospitals that counts.

So you mentioned Bernie Sanders's Medicare for All plan, which sounds pretty big, dickhead, but that's not the only Medicare for All plan because a bunch of his other maybe more punk rock opponents, in the case of Beto O'Rourke, have some different plans. Oh, then and they're all dog shit. What? What? What do you think of them and what are they? There's only one plan that that works in the US and that's Medicare for All. Anything that isn't that isn't worth shit.

Beto's plan, Medicare for America, formerly known as Medicare Extra for All is a C.A.P. plan. All these things. Sorry, I believe you can treat the symptoms without treating the cause of health care inequity in the US. So I'll go through these problems in a second, but I want to explain really quickly just what the core problems are in American health finance.

I think that'll eliminate why these things don't work. So the fundamental problems of American health finance, not just health care, but health finance are problems of cost and coverage. One coverage, some folks just don't have insurance. And among folks that do have insurance, a whole bunch of them don't have enough insurance. That's the idea of under insurance, which is becoming increasingly common. To the second problem is cost.

The cost of health care goes up every year. It happens in every country. It happens in the UK, too. But in the US, it happens at a much more extreme pace. And so for the past 50 years, we've been told we can solve only one problem at a time and that somehow working on one problem precludes working on the other. And so health care policy in the US frets about cost,

specifically the cost of Medicare and Medicaid. Cost is derived from a simple function, the number of health care uses of health care times the average cost of health care. Right? That's pretty simple. Cost times utilization, except we've been myopically focusing on the former out of people who use health care. So we invent things like premiums, deductibles and co-pays, try to encourage Americans to just not use health care so much

and therefore bring costs out. As if this were a matter of like how many beers you drink a week or how many pizzas you eat at night. And not a fundamental question of whether or not you could do this. In my case, many. That's right. That's right. You've got a high utilization function for pizza,

which is the most moral of all pizza utilization functions. But like when I go to my German doctor. Yeah, yeah, yeah. But like a utilization usage of health care isn't why health care costs are high. We know why costs are high. Costs are high because prices are high. That's because hospital executives and manufacturers and pharma companies just charge as much money as they can for the services they provide,

simply because nobody is able to stop them. That's why MRIs in the US cost five times more than MRIs in Australia, even though it's the exact same fucking machine during the exact same fucking procedure. That's why we have hospitals with skyscrapers and building departments of workers who seek to find ways to categorize patients and procedures as being important and expensive as possible. That's why in a flagrant violation in the rules of the market, when you add a new entrance to a health care market,

prices go up instead of go down. And insurance companies can't handle this and they don't want to. They're simply not malicious. They're just incompetent. Costs increase far beyond their capability to do anything about it. Instead of addressing the reason for these increasing costs, increasing prices, they instead choose to blame patients for using health care irresponsibly, like using too much of it,

using it the wrong way, going to the ER at the wrong time. That's why we have co-pays and deductibles to keep us from going to the doctor and making our insurer lose money. Because costs keep rising, insurers increase co-pays, deductibles and premiums. We're making it harder and harder for people who have illnesses to get the care they need, unless, of course, the government subsidizes them for that privilege. So, Tim, I have to jump in for a second.

Milo and Riley are losing their minds because Riley's lived almost his entire adult life in Britain and Milo is from Britain. They're like, what the fuck is this hell planet? What is this nightmare dungeon we've been trapped into? Like, they've never heard this shit. Whereas I'm from America and I'm just like, oh, yeah, the thing I've grown up with of watching my entire life. Most of what Tim was saying was more or less what I already understood.

But I just started losing my shit because I was laughing at the idea of going to Australia for a cheap MRI. Yeah, just hop in the back of the yoke. We'll sort that out for you. I mean, in my case, I know it abstractly, but hearing it all at once, it's like, wow, this is all I talk about. This is all I think about. Me and my girlfriend have a lot of fun together.

Damn, the state of Iowa, more like Iowa Hospital, a lot of money. Am I right? Good Lord Jesus Christ. Tim, do you want to replace a UK based comedian on a podcast? All I would do is laugh at all the jokes. That's good. That's welcome. But that's America, right? Like we've kind of like we've given ourselves over to the companies

to run these things. Like we already have privatized health care. There's this privatized health insurance and because fundamentally you can't solve this problem profitably, they blame us for getting sick and make our bodies the commodity that we have to leverage or negotiate ourselves against in order to like get healthier that we need. So we but we understand how to like solve these problems. Like these problems have existed elsewhere and they've been solved.

And so they like but we've been told we've got to focus on one of the other cost or coverage, cost or coverage, cost or coverage. Because it's presented as a technical problem, right? Right. It's like, oh, we just need to figure out the right graph or the right formula. The right app. Yeah, we need or the right app in our case. But it's a political problem where in the NHS, they at no point in the creation

of the I'm sure there's some graphs factored into the creation of the NHS. Sure. But it's not a it's creation was a politics first move, not a graphs first move. Oh, yeah, realistically, it came out of the emerging post World War Two demands that health care was a right. It was it was internet. I don't know if it was the league and it wasn't the nation. So it was World War Two. Like one of the I think it was the World Health Organization and something else

to like international post World War Two organizations began putting the language of health care as a right into their like constitutions. Of course, the US refused to sign that. But like this idea of like health care is a thing people were owed by the government was extremely in vogue after World War Two. And also in a real sense, I think it also it helps to think of it not as we're owed health care by the government, but that we working together have created a society with enough productive surplus that we can give everyone health care if we wanted to.

Absolutely. In effect, it's that we want we want that kind of self determination. Right. We that's how that's how I decided. Whenever I'm talking to like, you know, the people I run into who are like, but but Riley, if you like socialism, how will anyone have jobs or whatever? You live in a house. Yeah. Google Venezuela, as I often hear from people, or as I had yesterday, you're a socialist and yet you attended a university checkmate.

Libs, but it's in that, but that really it is about autonomy and control because, you know, it's like we were saying a couple episodes ago, all economies are planned. It's just who does the planning? And in this case, democratically, we would like to plan an economy where the hospital doesn't have a sky high billing department that, you know, charges you a thousand pounds or dollars for a toenail clipping. Right. Single payer health care is just emancipation. It's freedom from your own body, freedom from fear, the ability to live the life

that you want to live with the resources we commonly have that can certainly pay for, if organized properly, all of our needs. And so this is why I love talking in those very clear terms, like saying stuff like health care is a right because then you force like Republican senators to say what they really think, which is invariably hilarious. I can't remember who it was. I think it was like Ted Cruz or Tom Cotton or one of the many Republican shitheads who, when in response to people saying health care is a right, said,

well, if you say health care is a right, what's going to be a right next? Food? People are like, yeah, yeah, come on, fine. Republican, the staff to death party for the market. If it was CPAC or if it was a Republican convention in 2012, but remember, there was like a video question and answer session, Tim, and one of the famously like there was a gay soldier in uniform who like gave a question about, should I be kicked out of the army? And all the people in the crowd were like, yeah, fuck you.

We hate the troops, but there was also a guy who was talking about his health care premiums and he was like, you know, he had a preexisting condition and he ended his question with something to the effect of, you know, what, what should I expect from a conservative or from a Republican government with regard to my health care? And someone in the audience yelled out, let him die. And like, yeah, some say freedom is the best medicine. Oh, boy, sorry.

Sorry, I misspoke. Freedom is the only medicine you will have. And that to me just seemed indicative of what attitudes were like with a certain subset, like it referenced what Milo was saying, but sort of getting them to say what they actually feel, which is that death is good as long as more money comes to me. Having my appendix bitten out by a bald eagle in the name of freedom. It's, well, it's because for them, the, the, and for, and for many, I think,

people on the right here as well, and in the center, the market is not a tool for fulfilling human needs, like, you know, getting a kidney out if it's gotten all fucked up, rather the market is a tool for sorting society into winners and losers, and it punishes the losers and rewards the winners. So the winners get as many kidneys as they want, whereas many of the losers have to deal with sometimes no kidneys. If you don't die from kidney failure, then how are you going to learn from your mistakes?

A dark, a dark future where Lord Emperor Jacob Rees-Mogg has 4,000 kidneys and all of the newborn babies are born without kidneys and are forced to suckle at his teeth in order to purify their blood. You've seen my urine. It's the cleanest on the world. Here's a cool parallel. Organ donors are disproportionately poor people and rich people are disproportionately organ recipients.

We do have organs. We do have a virtual form of organ harvesting that go from the poor to the rich. Wow. Oh, my God. Yeah. Damn. And so, and so Beto will work in and the Center for American Progress have decided that actually this is good.

It's just that the premiums are slightly out of whack because because Obamacare was only a 99% solution or something like that. We can fix the fact that America's become a human organ farm with this graph. Well, right. There's this idea that you got to like solve these things. You're technocratic fixes, right? And like that's rooted in the idea that you can't like really solve costs and coverage at once.

The ACA, for example, was like a coverage solution. I wanted to expand coverage, but I actually solved the core of fundamental problems. And so one of the reasons that like you can't solve coverage without costs, right? Cost is as joint escalating. Nobody can stop it. One of the reasons the costs are so high is because people who set the prices have just massive advantages over small insurers, right? You've got a dozen insurer, a hundred insurers.

They're all pretty small. They need the hospital much, much more than the hospital needs the insurer. The hospitals charge three to five, maybe sometimes three to seven times higher, but they accept from Medicare to smaller insurers. So you consolidate and you build a single payer. And by giving the single payer singular control on payment for health care, it has leveraged to set prices. And because it's the only payer in town, hospitals need it more

than it needs the hospitals. This isn't radical. It's how it's done literally everywhere else. We use the power of universal coverage that we cover all people under one plan to stop private corporations from gouging us wherever we can. And we use new payment models to bring unit prices down. And eventually, hopefully, like that trend, that that builds the leverage to begin producing health care ourselves, I hope, to begin nationalizing health care

or drug production or things like that. But you simply cannot do this if we keep diffusing coverage and diffusing payment over a huge field of individual actors, a mishmash of government agencies, insurance companies, and stopgap solutions. There's no central actors strong enough to do any of the actual work. And so their fair programs like Medicare Extra for All, Medicare for America, Medicare Buy-In, Medicaid Buy-In are just entirely inadequate to the task. There's a lot of bad actors here, right?

There's insurers, there's manufacturers, there's health care corporations, there's hospital chains, there's all of the Baldwin's. There's nursing homes. But if you want to take them on, you could only do it like as a united front with a single payer. It's our only option. Otherwise, we just capitulate to being dominated by them again, forever, forever. And we've given these like jumbled private markets 50 years to figure things out

and just keep giving us worse coverage, higher costs and more need for government intervention. So why pump more public subsidy into their revenue sheets? It's like there's space for privatized Medicaid and privatized Medicare within Medicare Extra for All. There's space for fragmentation and multi-payer models in Medicare for America. They reflect a kind of near obsession with the status quo, a kind of genuflection to the hegemonic domination of employers and insurance companies and their health needs. And this simply can't handle any of the core problems we actually have.

And so therefore, all these reams of paper spent on these plans, all these efforts to just help the insurance companies continue to exist, probably because they get donations from insurance companies are a waste. It's a total fucking dog and pony show, horse and pony show. I don't know who does show the ponies, but it's that kind of show. It's a natal farm. Thank you. It's in the Spanish. I was going to add to because obviously more than half of our listeners are British

since we're based in the United Kingdom and we cover British politics. I don't know if a lot of British listeners know this, but in the United States, most people, correct me if I'm wrong here, Tim, most people get their insurance through their employer. And America has at will employment by and large across the board. So if you in most people's jobs, you can be fired at any time, which means your health insurance can be terminated at any time. It doesn't matter if you have. That sucks.

It doesn't matter if you have chronic conditions. It's so hard to get fired in the UK. Yeah, exactly. That helps you with your performance. Well, that's literally that's literally the argument they make is that people work harder to keep their jobs because their children might die from lack of insulin if they get fired. Oh, yeah. I mean, yeah, it works. Yeah, it's also shaking. Exactly.

And that's that's the thing that I don't think it's just an organ farm. I mean, I just don't. I think that's the thing that I that I having only moved to the UK like seven months ago is that people in the UK don't realize how bad it can get and people in America don't realize how much people don't have to worry about this shit. How much how abnormal America is. Yeah, taken for where Liam Neeson's kids are just being held hostage by Kaiser Permanente.

There's nothing he can do. I have a very particular set of skills, but I've always been self-employed. Leaving me completely defenseless in the face of this. I don't know why he sounds like Russell Crowe. Father, father to a murdered son, husband to a murdered wife. I will with a huge hospital bill. I will reduce my co-pay in this life or the next. Oh, my goodness.

So this is this is the state of play in in America, where it's sort of where everything is bad. And many of the proposals on the table seem to either at best will do nothing and at worst will make it considerably worse. So I'd like to and are in classics style for us. Go across the go across the Atlantic and a little bit back in time to understand that the NHS as much as we've been sort of lauding it today is, in fact,

not the paragon of wonder that you might think it may be. And this is down failing organization. Very bad Christmas party. This is down to the actions of a certain Mr. Tony Blair. Oh, yeah, that guy again. I don't remember him doing anything bad. I'm pretty sure that he's a fine, upstanding man. So basically when new labor was elected in the late 1990s,

Tony Blair marked the trend first said, OK, we are going to bring health spending in the UK up to the European average, which meant like they were injecting an extra couple of billion pounds a year in like real term spending, which is very good. Like that was a laudable goal. But what happened? There was this transformation in new labor in like 2000, 2001, in the 2001 election, new labor was facing all these accusations

that like it had not managed to reform to make good on its promises to reform the UK's what felt like more abundant institutions. So despite like extra investment being made in health, the actual improvements weren't really happening or they weren't happening for a lot of people because it probably wasn't enough investment or in a very Blair way, much money would have been spent on administrators, checkers, assessors, managers, optimizers, target checkers, etc, etc, etc, because that's what the Blair

sort of way to improve stuff was. We spent lots of money on checking whether you're OK. Yes. And so what happened was that there was this mass defection of middle class people from like Surrey and the home counties who were all skipping out of the NHS altogether and were basically saying they would vote for a party that would allow them to not have to pay for it more or less. So does that sound does that attitude sounded all familiar to you, Tim?

You know, I think I might have run into that a couple of times in my travels across across America. I can't imagine somebody saying fuck you to a federal health care program just to spite people, but I guess it's a universal tendency. In order to in order to continue because the whole thing he had to do is he had to thread this needle of he had to provide the kinds of extremely good service that like middle class home counties speak to your manager types demand with the NHS, but at the same time he was there was he felt

he couldn't tax them more for it. And so he said, well, we're going to do what we always do when we're faced with a political problem that will require us to, you know, be a labor party. Take over the world. No, no, I know that's pinky in the brain. Close. We're going to fuck it up slowly. What's that a Chris Brown song? So Blair decided to turn health care into a market from 2003.

And these things called independent sector treatment centers began springing up around the country. And more importantly, NHS hospitals went from being part of the Department of Health to just being independent trust, essentially allowing them to operate like a private business, but where there was a single payer still. And what's really interesting about this is that the way that Blair thought and Brown thought performance would be driven is if they said, OK, we're going to set a number of targets.

So for example, we're going to say that trolley waiting times have to be at a certain a certain length or you're going to get your funding cut more or less because that's the in a marketized system. That's the only way you can improve a service if you're a single payer is by not paying for any more. So it's a way of just defunding all the hospitals that probably need more funding. And the fifth target spoiler alert, it was Baghdad. Right.

As opposed to, of course, funding hospitals that need more help because the prevalence of sicker patients and need more money to take more care of them. Precisely. And because this is this is the homo economicist assumption that all of these marketizers have, which is they're like, OK, we assume that we think that if we unleash your creativity, you'll come up with a whole bunch of clever ways to like get people to reduce trolley waiting times. And that will improve the health service in ways that we central planners

couldn't possibly think of. It's basically just a way of like of just being just admitting you're really stupid and can't do anything and debt and begging for someone else to help you. But the interesting thing about the ways in which these targets worked is a lot of the hospital executives did then think of a very creative way to cut trolley waiting times like almost by half. Does anyone want to guess what that was? Did they get rid of the trolleys?

Basically. Oh, I love being right. It's so good, isn't it? Also, I just thought of a really dumb bit. No homo economicist. Yo, I'm a rational consumer, but none of that gay shit. Anyway. Yo, so what they do is they took the wheels off the trolleys and then said

they were beds. Oh, that is thinking three right there. Christ, that is that is multiverse thinking. But this gets back to like to Tim, what you were saying earlier is that like when these kinds of incentives go into a system, the incentive just tends to be for either to just to make the profit any possible way. And so you don't provide a better service. You just provide less care or it's to hit the target in any possible way.

You don't provide a service. You that's better. You just take wheels off of trolleys and call them beds. Yeah, literally sounds like the kind of shit they would say about like, oh, the Soviet Union was so clunky and not dynamic. Their factory is just based things on weight output. So they made all the lamps weigh a hundred pounds each. They could say they met their quotas.

And like, but we actually do that in the West just for health care. We all remember the old Soviet joke where someone comes into this hospital and goes, do you not have insulin? They say, no, no, with a hospital, it doesn't have trolleys. That hospital doesn't have insulin. And so and then in 2009, new labor doubled down on this again and said not just these sort of selected independent sector treatment centers can can can issue treatment with meeting these targets, et cetera.

But any qualified provider, basically, if you met a number of if you met like a number of psychs of pretty loose criteria, you could be a hospital. Are you in debt struggling to meet your monthly repayments? Have you considered becoming a hospital? If you just take the wheels off of a regular person, you can make them into a pretty serviceable emergency room. And so basically, it meant that a lot of a lot of these of these procedures, especially sort of either elective ones or sort of less sort of

immediately pressing ones were taking place in these other other AQP hospitals. And they were they were all run by this firm called Circle. Remember that because it's going to come up later. And also, by the way, just I was reading a story in the new statesman from a couple of years ago, while I was putting together the notes for this, which I'll link in the description where I sort of I took some of these facts from. He says that once one of these hospitals failed, it was called Hinchingbrook, then the local community tried to step in to like rebuy it basically

and just, you know, co-operatize it. But because of EU tendering law, once something is privatized, it has to be then put out to market in a fair tender and assessed objectively on a number of preset criteria. So they were then unable to re nationalize, if you like, the hospital that was taken over by a private firm and then run into the fucking ground. In the US, our version of that is go fund me's for rural hospitals. Oh, man. Oh, no. Oh, that never worked.

That's the worst part. Oh, no. That's even worse. Yeah. Excellent. Well, you'll see. We all hear about the go fund me today, where all the San Francisco residents clubbed together $40,000 to stop a homeless shelter being built. God, you like you skim read it and you're like, Oh, people got together $40,000 to build a homeless shelter. Wait, wait. No, nothing good happens anymore, especially not in San Francisco.

It's such a beautiful city with such ugly people. Oh, my goodness. God damn, how much is it worth to you that they don't shelter the homeless? Bitch, I'll pay you not to do it. It's like you get the farm subsidies for not growing alfalfa when there would be a glut of alfalfa. You just get paid. You stuck in debt. You could become a hospital. You could not house the homeless.

Listen, pal, you want to be a success every time a homeless person asks you for money. You mug them. This is kind of a tangential joke, but like the logic of American cities, San Francisco, Chicago, New York, et cetera, was best summed up to me when somebody made the comment about about Rahm Emanuel being so unpopular in Chicago. And they said that like, you know, Rahm Emanuel couldn't even get elected as dog catcher, which is sort of a famous sort of quip in America. And someone wrote like, actually, no, Rahm Emanuel eliminated the position

of dog catcher and outsourced it to a Saudi hedge fund that charges Chicagoans for not losing their dogs often enough. It's like it's the same. It's the same kind of that. Like whatever you think is horrible, whatever you think is like the most sci-fi Philip K. Dick nightmare, it's already being done. Richard Branson is usually behind it. Yeah.

We're sending all these dogs to a special care farm in China for this wonderful festival that they have. So now that's the basic groundwork of the erosion of healthcare as a public service in the UK. We've introduced all these internal markets, but it is still a single payer. It's just that the single payments are now going to firms that are like criminally incompetent, more or less. I don't know if I can legally say criminally.

I don't know if circle committed any crimes. So let's just say that our nightmarishly incompetent. To give you an example, Tim, recently there was a scandal where an NHS trust brought pap smears and cervical cancer screenings back into public basically operation because the private company that was running them fucked up its database and wasn't sending people reminders and wasn't sending the right data to the right people. And so a lot of folks missed their annual screenings. And some people who had results that would have required additional checkups

to potentially prevent them from developing more serious issues with cervical cancer didn't get those notifications because the entire company was just a complete fucking mess. But the default in this country in the last 10 years has because of the Tories has been that you always go for private first. Because they fail forward. Exactly. And there's just been spectacular failure after spectacular failure. But the thing about it is the UK is basically you elect a government and then that government's

a dictatorship. And like there's awesome. Except for now. It hasn't really been... Except for this one. This one's not really dictating much to anybody. I don't know. I mean the stuff with privatization right now even under the Tories,

it seems like it continues to pace no matter how fucked up the government it is. It keeps happening. Yeah, true. And they keep tendering contracts. They keep expanding shit. Well, they have to. They literally have to. I mean, look, Nate, on the one hand, some people get cervical cancer unnecessarily.

But on the other hand, certain shareholders bought a very nice sports car this year. So no one can really say if it's good or not. Yeah, exactly. So we've laid that groundwork. So we now know sort of what these AQP initiatives were. And so what that leads us to is our old favorite company, much beloved of the health secretary himself, Matt Hancock. That's just a reminder that is the private company that the health minister actually

endorsed in a newspaper in a paid advertorial. So you know they're great Babylon. Well, and to be fair, Matt Hancock knows exactly how healthcare needs to be, because he is sick AF. My man Parkour and all kinds of shit. So Babylon was founded in 2013. And this is, by the way, this is many of the articles that I'm reading in this in this episode are good articles that make good points,

which we'll link in the description, not the usual horse shit from the spectator talking about like, you know, why maybe if the Nazis won in Britain, it wouldn't have been so bad. Not that distant from stuff they've actually written. I mean, the Nazis can stop the S.J. Dobs. Not that far from stuff they've actually written. Whatever we make up to sound like hyperbolic, it's actually been done worse in real life.

That's the rule for healthcare in America and for politics in British media. Oh yeah. So Babylon was founded in 2013 by a guy called Ali Parsa, former Goldman Sachs banker who previously founded Circle Healthcare, the first private company to run an NHS hospital. Wicked. And like, it truly is a vicious circle as it all comes back around again. The same shit different decade.

Absolutely. I like that. You know what it is? I like that these guys, this is like Instagram Tory confidence again. What's what these guys have done is they took a hospital, they took it into private control, completely destroyed it through sort of incredible negligence and mismanagement. And then they were like, okay, we learned a lot about ourselves and about healthcare,

and now we're going to apply those lessons to doing it again. Yeah. Check out this new hospital that has a dog ears and tongue. God. So in January 2015, Circle pulled out of Hinchingbrook Hospital hours before it was rated inadequate and described by like the Care Quality Commission as having significant failings. And as much as there were substantial and frequent staff shortages in A&E

and concerns about how the hospital was running in general, Circle, of course, said a number of factors played into his decision to step away from Hinchingbrook at that time. A bunch, probably not just catastrophic failure, but like, you know, they wanted it to be more commutable. Who could say? The lunches weren't good enough and they dig out of that. Yeah.

They had to call it the lunches. You know what? It just, it wasn't the right hospital for us. You know, it was a toxic relationship. We had to get out of it. They were practicing self care. Yeah. This is Health Justice, self care by Ali Parsas, you know, Babylon and Circle.

So Babylon with its app GP at hand is the same people trying this different strategy. So I think a lot of people remember what GP at hand was if they've listened to our show with Rob Delaney, but a quick refresher. It's patients basically get a Skype call with the GP and then they can get stuff like prescribed to them through there. It's basic telehealth, but that they have a chat bot that sort of talks through your symptoms and then triages you more or less. And so GP at hand takes advantage of two different NHS systems.

General medical services, which is how GP's are actually like funded by this formula. So it's like per patient, it's about 90 pounds or so, but it can go up to about 150. And then this new invention called out of area registration, which was designed to increase competitiveness so that GP's would offer better services. So I guess like if you, I don't know, get a cold, they make you like extra healthy. Like you have a reverse cold. And so you can now register for GP's outside your local area. So for GP at hand, anyone who lives and works in London can sign up

because what they did was they took over one GP's surgery in Fulham in West London. And then the Hammersmith and Fulham Clinical Commissioning Group, which is like the channel of money from the government to the practice. Again, anyone who works in the NHS is probably like, you're massively oversimplifying it. And you're probably right, but whatever, I'm the one with the podcast. A famous decision that's been made many a time. Indeed. So now GP at hand has 41,690 patients on its books,

as opposed to the amount that a normal doctor would have. But it's forcing this one CCG in Hammersmith to pay for all of them, despite the fact that like the vast majority of the patients just live and work in London. Local care authority pays for all these patients using one weird trick. So it's as FGP at hand is one doctor with 42,000 patients. And it gets paid because it gets paid by its borough. The borough is paying for a lot of out of borough patients. Is it your sign? More or less.

Got it. Yeah. And like the, well, it's not necessarily the borough. It's called a clinical commissioning group, which is like an NHS, it's like an NHS body that's at arm's length from the trust and the department. I mean, I love the, that's the other great thing. I love that privatization has made this so simple. It used to just be there would be a department and everyone went to government employees and it just sort of worked.

Now, in order, now money has to pass through like 12 different entities in order to like pay my GP. It's more efficient. Yeah. Absolutely. Well, the money goes through more entities. So more people can make sure it's still good. The NHS actually has four stomachs. And it chews the money multiple times. So that's where you get the delicious health milk.

And so basically this, um, this group has this, this CCG is having a massive trouble actually like with dealing with the financial strain put in it by Babylon. And here's where we get familiar again, forcing NHS England to bail it out because a private company fucked things up. Damn, whom, whom could have predicted? Well, that's the first, that's the first time that's ever happened. So no one could have predicted that.

Yeah, absolutely. Because actually what's happened is that it's just basically making healthcare in like West London worse because now they have to find like millions and millions of pounds to pay for like, to pay for people to get, by the way, quite substandard care. Yeah. Well, because also like all of the way that the private tendering works in all of the privatized industries in Britain, uh, in terms of the ones that were formerly state run, is that the whole thing is just basically a massive scam because the companies have to tender to run it cheaper than the state could run it, which is pretty much impossible because

the state has huge economies of scale and also the state doesn't have to make a profit. So they come in and whether it's like the fucking trains or the health service or whatever, and they just bid like 10 quid lower than like whatever the state could do it at. And they know they can't do it for that price because it's like literally impossible. But then what they do is they just fuck it up and then the state just has to come in and bail them out. But it doesn't matter because they've already got all their fucking money. And it's like, this happens every fucking time. And the British government is just like fucking like Homer Simpson just blundering around going like, Oh, maybe this time they said they said

they could do it for 10 pounds, run the whole of Britain. Like maybe they can. It's like, no, they fucking can't. They're just, they're just going to spend it on private jets to go to, you know, parts of international waters, which I hear are very nice and have parties, which I'm sure are completely legal. But that is all they're doing with your fucking money. And in the meantime, there's no wheels on the trolleys. Nothing is getting fucking done. And in the end, like the bureaucrats have to come back in and go, Oh, the government has to do it again. We have that exact same process in the US through Medicare Advantage, which is privatized Medicare, in which a private insurance company like Aetna or whatever will say, I can ensure this

guy for $4,000 a year. And Medicare says, okay, yeah, we'll give you $4,000 to ensure this guy. And then at the end of the year, Aetna says, hang on a second, this guy had cancer and diabetes. There's no way we can afford to make a profit on this guy. You better give us an extra three or 10 or $100,000 to keep him insured. And Medicare goes, well, I guess we have to. And so they do this at scale. United Health got sued for $3 billion of fraud over a course of four years. So they would just take people and like get them diagnosed with everything possible. So they could report to Medicare saying, Hey, this person's also got emphysema and lecanthropy. And also, we need these subsidies. It's called risk adjustment. And it's a massively

profitable way to make money. And it's a horrible way to run a health insurance program. He's got demons in the vapors. We had to spend so much money on exorcisms. It's basically a scam. Yes, absolutely. It's a legal scam. It's a super legal scam. But then of course, everyone's worried about work requirements because they don't want their Medicare tax money or their NHS tax money or whatever. They don't want it paying for someone who hasn't worked for it. And meanwhile, it's at the same time, it's like, yes, focus on the Cadillac Welfare Queen who's getting extra kidneys on your dime and don't pay attention

to me who's like, again, using it to go fly to some very interesting and well attended by celebrities, private jet parties and international waters. Or in the recent case, apply insane, onerous work requirements basically to punish people who are on Medicaid. Saying that they have to attend like 80 hours a month of job searches or like they have to sign into like an app literally once a week and report all their numbers of times they've applied for jobs. How American is that though? These are places like people who like don't have internet connections. Like some of these like Arkansas is a state that has some of the worst broadband penetration in America. They just do it to be cruel to deny people because in the bureaucratic

process, people will give up and then they can they can, you know, scam them out of their health cancer. Have you considered the restorative power of work? Yeah. I mean, what they didn't really consider when they talked about the end of history in 91 was that whilst Russia did end up becoming like the capitalist West in a lot of ways, the capitalist West ended up becoming so capitalist it's now the Soviet Union. Like crippling bureaucracy dominates your entire life. So you don't do anything anymore. No, I cannot go to local swimming pool in Indiana because I have to fill out 15 forms about whether or not I have syphilis, but I cannot find out whether I have syphilis because there is only

one doctor in the entire town who is dead. I want to add one more sprinkled environment story, which is that in Tennessee, Tennessee passed a really aggressive work requirements program. And of course, everybody on Medicaid is already working if they can. Like there's like not many if any people who aren't working and who are encouraged to through through Medicaid. A lot of folks have disabilities are already working with jobs. But Tennessee now has like a really extensive work requirement paperwork you got to fill out, which means that you need to have the offices who supply Medicaid, be able to process the paperwork. But they spent no money, they allocated no money in their Medicaid budget to actually process work requirements,

paperwork. So now it's backed up by months and months and months. There's no even like centralized database of this information. The offices have their hours cut. It's designed to fail. It's really just like humiliation and punishment. Yeah, I mean, when you think about it here in the UK, that kind of sounds like applying for things like for DWP, like applying for the personal independence payment or applying for universal credit. The same thing here for what used to be like things like allowances for people with disabilities. You have famously have stories here in the United Kingdom, which has been really bad recently about finding ways to sanction people and cut their benefits. Like people who, you know, someone who's got like muscular dystrophy,

who's confined to a wheelchair and they're like, oh, you can work a normal job because you're able to make a cup of tea with an electric kettle or something like that. Or quite frequently, they'll declare dead people fit for work. I mean, damn, like human statue, that's a profession. Dead people would be great at that. I think the reason, I mean, we all know the actual reason this keeps happening is, you know, is our old friend capitalism. Is it the international Lizard conspiracy? Yeah, I was going to say that. But the other thing is like, what I notice is that these people are just like the governors, especially even the ostensible liberal ones, the sort of the politicians, are just endlessly sort of ensorcelled and enthralled, either by a

catchy title like Medicare Advantage Extra with for America, or an app in the case of Matt Hancock, where it's like, oh, no, it's different this time. It's not exactly the same thing that happened last time. This time, there is an app with AI. I just want to quickly jump into the AI. I did a little extra research on this as well. So from the from the article, the initial article from Wired that we will be linking, one ex-staff member of Babylon, who asked not to be named, said the company's AI was significantly overhyped. They separate their branding and marketing from the clinical side and stay away from any kind of validation in clinical trials. They really don't want to do that because they see that clinical trials as extensive, boring and time-consuming.

Wow. Damn, I didn't realize that clinical trials were so lame. Damn, what are you, some kind of fucking nerd? You test stuff out. If you do clinical trials, you'll get no pussy. That's why here at Viagra, we do no clinical trials. I mean, my dick exploded, but it rocked. I didn't have to fill any boring paperwork. I grew eight dicks. What did I want to do? What do I do? Jeremy Kyle being like, I have nowhere else to turn. Additionally, the flaws in the AI algorithm identified by an NHS consultant specializing in

patient safety include critical red flags, such as chest pain. So this doctor did was he sat down and described all of the symptoms of a heart attack to the chatbot who then said, you should sit down and relax. Always good advice. Hey, man, chill out. You're having a heart attack. You know what's stressing about it? It's not going to make it any better. You're entering the symptoms of a heart attack and it's like step number one, cut those toxic people out of your life. Yeah, it's just the secret. It's not called the secret. It's just an app. Oh, no, the other one. That's a failing heart. You want to get rid of that heart out of your life. Very bad Christmas party that I had. Another sort of point I'll note is that

it asked if a 66 year old woman was pregnant before failing to suggest a breast lump could be cancerous. Fantastic. Love it. Well, you never want to presume. No, you don't want to offend. Absolutely not. I trust AI to fight me in quake too. I trust AI to, I don't know, make that like Google deep dive art or whatever and nothing else. So to wrap up on Babylon, the company's plans for national expansion, so right now it's just fucking up London medicine, stalled in July of last year when basically Birmingham just said, no, you cannot come here. However, in February of this year, NHS England approved its expansion plans. Also, Babylon is threatened to sue the independent health regulator, the Care Quality

Commission, over a critical report that would have stood in the way of this expansion. The fuck? What is wrong with this fucking guy? Like, how is it possible for them to sue a regulator for saying to this clearly like fucking ridiculously incompetent company, no, you are shit and you're a scam. And if you take over services, people will die. And then they're basically like doing them saying like, it hurts our feelings when you say we, it's our right as a business, which is the best kind of person to make money by scamming the government out of money and letting people die in the process. That's what freedom is. And it's like, I mean, I'm frankly, people can suck so much of my dick. I'm impressed. I think that's, that's, that's pretty

big bald of them. I really respect that. It's American. It's American style. Bald's so large, you've probably got a serious condition that their app would not diagnose. Health Secretary Matt Hancock also claims to use this quote unquote revolutionary and brilliant system. In November, Hancock was featured in an evening standard advertorial sponsored by Babylon. I unironically love Matt Hancock. He's such a beautiful moron. He's such a sweet, sweet boy. He's like, he's like the slow brother of the bullies at school. And like, if he was just in a better family, it wouldn't have ended this way for Matt Hancock. Matt Hancock, he should be like fixing motorbikes somewhere in, in Shropshire,

you know, and just saying like, Oh, not many people come by these days, you know, but he's been put in charge of the health service. And it's, it's unfortunate. You know, it's like, it's like giving, giving a dog control of an aircraft carrier. You can't really expect him to do any better than he is. Oh boy, he looks over. I just googled him. He looks overwhelmed in all these photos. He is like a golden retriever in charge of an aircraft carrier. Every picture is like, one of his sort of like, I'm a really, I'm a young, cool guy who is going to revolutionize healthcare in Britain. Like PR appeals was to film himself doing parkour and release it on Twitter. Needless to say, we have never forgotten it.

He said, it's a great way to learn about your body. If you learn more about your body doing parkour, then you've opened the Babylon app. Yeah. You're having a heart attack in the app suggests. Have you tried parkour? It helps some people relax. Our US version of Matt Hancock is Sima Verma, who's the head of Medicaid, Medicare Services, who just got busted for spending $2 million on brand consultants with public money, which is pretty cool. Oh, that's awesome. I love to bust. I love, I love all of these. All of these people are my beautiful family. Also, Sima Verma was kind of like insane on Twitter. Wasn't she like, she was, she like had a Twitter account in which she was basically

trying to like get in people's mentions about, about Medicare for all. Like if I remember correctly, she was kind of like embracing the troll mentality to a significant extent, which is obviously something I want in a person who's trying to like make, you know, make actual death panels for Medicaid recipients. It's extremely normal. Yeah. It's very cool. However, I do believe that Milo has to go do some weird Russian thing. I have to return to my home planet. I'm doing a show for doing this big Russian comedy show in London tonight. God only knows what's going to happen. So if you're listening to this in the past, come out to that. Exactly. If you're listening to this in 1999.

Stop me from being born. So Tim, thank you very much for coming on today. Thank you for having me. Thank you very much. I had a lot of fun. Before we, before we hang up, is there anything you want to should tell people? You should definitely plug the book if you haven't, or you did a little bit, Tim, but if we get more details, that'd be awesome. More details in that book. Oh, yeah, I got a book and I got a newsletter. My book is called Health Justice Now, Single Payer, What Comes Next. It's mostly for an American audience, but everyone's welcome to read it. It describes what we've got in the US, like what we have insurance, why is insurance,

how is insurance, what is single payer instead. And then beyond that, what's a broader vision of health equity and health justice. You can find that at bit.ly slash health justice now. The book drops in August, which is I guess not too far away, but not right now. I've got a newsletter where I write about once a month or every couple of weeks about healthcare issues that I'm thinking about, health policy, health finance. I just wrote about Medicare Advantage last night, which you can read if you want to. That's at tinyletter.com slash error, E-R-R-O-R. I got an early username and didn't think it through. So otherwise, it remains only for me to say that we do have a Patreon five bucks a month,

second episode. You can subscribe to it, for example. That's something you could do. You could do that. I recommend it even. Yeah, our Patreon will diagnose you with correctly with the health conditions exactly in the same way that Babylon's app will, not at all. And I think we've also just ordered a new run of limited edition t-shirts, which we're going to be getting printed up and put on sale soon. So they're looking extremely metal. So do keep on watch for those.

The t-shirts are not made of metal. Oh, that'd be cool. And finally, yeah, this is a t-shirt. You're going around like David Vance. He's reporting on this, reporting on the knife crime in London who has sued a full armor. Yes, stabproof podcast t-shirt. And finally, come see us, your favorite guys at Bristol Transformed on Friday, April 5th.

We'll also put the link to that in the description. Anyway, if the country hasn't burned down, then we'll see you then and there and all that great stuff. Oh, also, Smoke Comedy on the 10th of April, featuring friends of the dang show, P.N. of Ellie and Alex Keely. There'll be a link to tickets in the description. Please come to that because it'll be fucking great. All right. Oh, Matt Hancock. All right, fantastic. Well, Tim, thanks again for coming on.

Thank you all for having me. Really appreciate it. I'll talk to you later. And I hope you all enjoy your commutes or your dinners or your shit or whatever it is that you do when you listen to this. Well, your heart attack while you're sitting down relaxing and listening to an episode of Trashy. Or your misdiagnosis of elephantitis because your nuts really are that big. Later, everybody. You