The Economics of Healthcare: Crash Course Econ #29

The Economics of Healthcare: Crash Course Econ #29

Adriene: Welcome to Crash Course Economics
I’m Adriene Hill Jacob: and I’m Jacob Clifford. Today we
are going to talk about the Economics of Healthcare. Healthcare is different than some of the other
markets we’ve talked about. Adriene: If you’re having a heart attack,
you’re not going to shop around for the hospital with the best prices. And a hospital
emergency room isn’t going to wait for your credit card to go through before they treat
you. But we’re getting ahead of ourselves. Let’s get started. [Theme Music] For a lot of reasons, Health care is different
than the other markets we’ve talked about. First, you never know when you’re going
to need it. It’s kind of hard to plan to fall off your bike and break your arm. And
after you break your arm, that visit to the emergency room is going to be expensive. That’s why we have health insurance, whether
it’s private or public. Private insurers periodically collect money, in the form of
premiums, paid by individuals or their employers. Public insurance programs collect money from
taxpayers. You’ll hear some countries have free
healthcare, but it’s not “free.” They’re paying for it: either directly,
through insurers, or through taxes. Let’s work out all the details in the Thought
Bubble. Jacob: So, Canada has a public insurance system where the government funds healthcare for everyone through taxation. Doctor’s offices tend to be private businesses
that get paid directly by the government. But, hospitals and operating tables
are public property. And the hospital staff are public
employees, sort of like public schools. This is often called a single payer system
since the government is doing most of the paying. Canadians have to pay for prescription
drugs, eyeglasses and dental care themselves or get them through supplemental private insurance. Now, France technically doesn’t have a single
payer system because health care providers are paid by several non-profit insurance funds. All citizens are required to get health insurance
and they’re free to choose their doctor. Unlike Canada, most French providers,
including hospitals, are private businesses. The UK is different still. It has a socialized
healthcare system which is funded and controlled by the government through taxes. The majority
of doctors, specialists, and hospitals are all paid by the government, not insurance
companies. Today, the US has little of everything! Almost
all providers – hospitals, clinics, doctor’s practices – are private firms. Most households
with adults under 65 are covered by private insurance, either through their employer or
through individual policies. But the US has single payer system for those
over 65 and those below the poverty line. Medicare is a taxpayer-funded public insurer
that pays providers to care for seniors and Medicaid is a similar program for low-income
households. Oh, and the US also has a small UK-style system with government-run hospitals and government-employee doctors. But it’s only for veterans and
it’s called the VA. Adriene: Thanks Thought Bubble. So let’s
get down to some numbers. Economists evaluate the effectiveness of a healthcare system on three criteria: Access, Cost, and Quality. According to the Census Bureau in 2014 10.4% of Americans didn’t have health insurance coverage, down from 13.3% in 2013. Two thirds of Americans had health insurance
through a private Insurer. The vast majority got coverage through their employer and
the rest bought individual plans. About a third of Americans had health insurance
through a taxpayer-funded government insurance plan like Medicare, Medicaid, the VA , and healthcare
for active-duty military and their families. So, two thirds, plus a third, plus 10% uninsured
adds up to more than 100%. That’s because somebody who switches from private Insurance
to public Insurance gets counted in BOTH numbers. That’s just the way the Census
does it. Let’s talk a little about the uninsured.
Compared with the general population, people without insurance tend to be somewhat younger,
earn less, and be more racially diverse. Because Medicaid covers people below or near the poverty line, the uninsured are usually not completely destitute. They often work a part-time or low-wage job,
which puts them above the Medicaid threshold, but their employers may not offer insurance
to part-time workers. If an uninsured person gets sick or gets hit by a bus, they can easily
get stuck with six figures in medical bills. And those unpaid medical expenses drive up
costs for everybody. Jacob: This brings us to the cost of healthcare.
Good news Americans – We’re Number One!! Well, actually, it’s not that great. In 2012, the U.S. spent an average of $8,745 per person on healthcare. Other rich countries like Switzerland and
Norway spent a little over $6,000, and countries like Germany, France, the UK, and Japan spent
in the $3-5,000 range. So the U.S. is spending twice as much, per
person, as most other developed countries. Put another way, the US spends the same share
of GDP just on Medicare – as most countries spend to cover their entire populations. So why does the US spend so much more than
other countries? Well, some argue that it’s due to high quantity of care per person. Since
insurance companies, rather than patients pay providers, patients might want more care,
like tests, procedures and treatments than necessary. It’s like an all-you-can-treat buffet. You
know you shouldn’t go back for that fourth General Tso’s X-Ray, but it’s just so
delicious! The RAND Health Insurance experiment a few
decades ago found that requiring patients to pay for a portion of their health care
cost deters them from overconsuming of healthcare. That’s one reason that in the US, many insurance
plans have deductibles, a form of costs sharing where the the patient is required to pay a
part of the cost before the insurance kicks in. Many economists say prices are also a problem.
In most other countries, insurers pay between $200 and $400 for an MRI. In the US, the price
is around $1500. And it’s not like the US MRIs are somehow “better.” They’re exactly
the same machines. And you can go down the list of treatments
and procedures – in nearly every case, US providers are being paid 3, 4, or 5 TIMES
more. This is because the US doesn’t have a unified
system that can aggressively negotiate with doctors, pharmaceutical companies, and other
providers. They point out that Medicare and Medicaid often get a significant discount
compared to small insurers. Another reason for the high costs is the blizzard
of paperwork generated by the interaction between dozens of insurers and thousands of
providers. Both the insurer and the provider have to employ a team of unhappy people in
cubicles to haggle over the reimbursement rate for an appendectomy. These teams add
to the administrative costs of healthcare. Adriene: So which problem is driving healthcare
costs? Quantity? Price? Administrative costs? When you dig into the numbers, the US consumes a pretty high quantity of tests and treatments per person. But it’s not radically higher than most other countries, and several countries, like Germany, do even more. Likewise, the US administrative costs are
also higher, since a lot countries drastically reduce their billing paperwork with a universal
insurer. But that cost explains only about 10-20% of the cost difference. Most of the
difference comes from the fact that US providers are paid much higher prices than their counterparts
in other countries. Okay, let’s talk quickly about quality.
There are a lot of ways to measure the quality of a country’s healthcare system. Let’s
look at a few different metrics. According to the Kaiser Family Foundation,
The US has higher rates of hospital admissions for preventable conditions, and it has high
rates of medical, medication and lab errors. The US DOES stack up pretty well in terms of diagnosing and successfully treating conditions like heart disease and some types of cancer. But remember, spending per capita is much
higher in the US than the rest of world. Reforming the health care system is difficult,
thanks to something called the Iron Triangle. The Iron Triangle is a section of the Western
Atlantic ocean where ships and planes are frequently spirited away by extra terrestrials. Sorry, I’m terrible at triangles.
That’s the Bermuda Triangle. The Iron Triangle refers to the mutually beneficial
relationship between members of Congress, government bureaucrats, and lobbyists. Bureaucrats want to protect their funding
and jobs, Congressmen want to get re-elected, and lobbyists want to advance the interests
of their clients. And they all end up working toward policies that maintain the status quo, and aren’t necessarily in the best interest of the people. But they’re not worthless. The Iron Triangle
got it together in 2010, and the US Government passed the Affordable Care Act. Sometimes
called ObamaCare. This stab at reforming the American healthcare
system has been controversial, to say the least. Let’s take a look at what the law does and
doesn’t do. ObamaCare did not set up a UK-style system
where hospitals are public property and doctors are public employees. It also didn’t establish
a Universal Public Insurance system, like expanding Medicare to everyone. Instead, the Affordable Care Act tries to
increase health coverage by requiring private health insurers to insure everyone who applies,
charge the same premiums to people of the same age, and cover pre-existing conditions. To prevent otherwise healthy people from only
buying health insurance when they get sick, it requires that everyone obtain health insurance
or pay a fee. The law also subsidizes health insurance premiums for those who can’t afford
to pay market rates. So that’s what ObamaCare is supposed to
do… is it working? Well, it has reduced the number of Americans without insurance.
So access seems to have improved. The Affordable Care Act also has
provisions meant to deal with costs. And that’s a little more difficult to assess. The act rewards doctors for cutting costs,
and requires greater price transparency. It also mandates a move to electronic record-keeping. As far as improving quality goes, It’s probably
to early to tell. Jacob: In the end, the economic debate over
healthcare is a lot like the debate over other topics we’ve covered in Crash Course Economics,
like price controls, climate change, inequality, and education. The recurring question is:
when, if ever, should the government get involved to help markets achieve the most effective,
efficient, and fair outcome. Obamacare reflects the peoples’ attitude towards
government and capitalism: Americans don’t fully trust either one of them. Healthcare
reforms have left private insurers and providers in place, but at the same time has increased
regulation. Insurers are now required to do things they wouldn’t normally do, like cover
people with pre-existing conditions. Adriene: So, that’s the American healthcare system, which is weird and expensive, and necessary. That’s also the end of our textbook economics
episodes. Jacob: And so I’m moving to Canada to write a textbook and enjoy some of that sweet, sweet, subsidized health care. Adriene: And I’m going to stick around and
talk about the economics of things like immigration and social security and happiness. Jacob: Thanks for watching. She’ll see you
next week. Thanks for watching Crash Course Economics.
It’s made with the help of all these awesome people. You can help keep Crash Course free for everyone
forever by supporting it at Patreon. Patreon is a voluntary subscription service where you can support the show with a monthly contribution. Thanks for watching. DFTBA.


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    david doggy

    What about 3rd party billing .. and walk by doctors billing … i think it the hospitals are crooked like a crooked mechanic… i can have a back operation in Europe for 30,000.00 on the us the same is 120,000.00…. in eurp the outcome is better in the outcome of this operation is poor and complications can lead to death.. plus even if you have heath care your out of pocket coast in usa is higher then the coast of the care in Europe. Pluse you have 3rd party billing.. witch can double and what the insurance want pay when you die guess what these vultures or Hospitals go after your estate and leave your children with nothing

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    Sam Judge

    Are you trying to push for public healthcare? it seem your trying to make Private sound bad and favor public service that cost less… as You do know UK and Canada Has high Tax rate right? This seem like a propaganda for socializes healthcare, as it goes on and on how costly insurance is, while failing of what patent could individually pay for, not to mention hospitals doctors and equipment are lately regulated highly that would cost a lot from government restrictions. I may not be a full expert on economics to this, I do know that having generalities planing and price fixing will not make best healthcare for people, as you will end up rationing supplies and make patents wait more for health, also they be tax a lot more and it will continue to get costly in the long run.

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    The Joker

    My mother just found out she had a spot on her liver. She is thankful to not have to wait in line like she would under Universal Healthcare.

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    0:39 healthcare is expensive and unpredictable that is why we have insurance.
    5:37 healthcare is expensive because we have insurance.

    Which is it or is the dragon chasing its tail?

    4:50 requiring people to pay for their healthcare reduces expenses/demand.

    Perhaps the answer is to get rid of Medicaid, Medicare, and insurance and replace it all with a true market and required health savings/retirement accounts this reduces the cost by 75% ( 5:05 ) and demand of health care and still fulfills the need for people to pay for emergency healthcare. That is how it is done in Singapore. That is also how we take care of other emergency needs like totaled vehicles or being unemployed. At the very minimum, this type of healthcare system should be available to people who want it.

    7:17 the Iron Triangle wouldn't exist if Medicaid and Medicare and the FDA didn't exist. With the FDA out of the picture, people would be free to consume whatever they want including medications that are experimental without having to go to Mexico. This would drastically reduce the cost of medication. Without the Iron Triangle, there would be less arbitrary price hikes and inefficiencies in the market.

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    Justin Dean

    The escalating price of health insurance is a result of government.

    1.Governmental programs like medicaid and medicare caused extreme inflation in the health market. This is due to the government providing coverage to some people through the tax dollars of everyone. This may sound like a good idea on the surface but the adverse effect of this is that more people go to the hospital than otherwise would be able to, once more people flood hospitals than the demand on them goes up and the prices will follow to accommodate the increased inflow.

    2. Another aspect that effects prices is the state provided protection preventing health insurance companies from selling insurance across state lines. Insurance companies lobby their state representatives to prevent out of state insurers to come in and increase competition. This fundamentally disrupts the law of supply and demand, creating artificially higher prices for consumers.

    3. Due patents, another government program, medical companies are able to create medications and then patent them, effectively preventing anyone else from using this drug without first paying the company, aka a monopoly. This creates an environment where these companies can charge exorbitantly high prices for their drug, this is then covered by health insurers and the inflated price is passed onto customers.

    What people don't understand is that problems are much bigger and their roots go much deeper than most are willing to look into and because of this people come to quick fix conclusions. Of which, usually involves turning to the government. Universal healthcare does not address any of these aforementioned issues, it would only exacerbates them. This crony capitalist, quasi free market system only breadths corruption, where a few win and the majority of us lose.

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    [Grand Emperor] Nathanos Hausladen

    Just to let you know, Obamacare has failed, so has every single Government subsidized single payer healthcare system.

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    Useless Cause

    I am disturbed with the flicker. My epilepsy hits with blinky lights. I had to scroll down to avoid seeing the video. If you can not change the flicker PLEASE add a warning to the title.

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    Nice video, love it and hope you upload more of this. Oh and can we be friend by supporting each others channel? I will love to sub back.

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    Ronald Barrow

    I would be interested to see you discuss the impact of Medicare on charges vs. actual costs.  Medicare reimburses about 13 cents on a dollar which reduces the actual cost figures.  Medicare though requires that third parties be charged the same as medicare, therefore insurance companies are billed at the same rate and negotiate a reduction of reimbursement while uninsured are stuck with the entire charge.  Has not the influence of government (Medicare) actually created our healthcare crisis.

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    Maxine A.G. Guess

    Canadian Healthcare is excellent. I worked ER for years and must say…You will NEVER get a hospital bill and there are no co-pays.

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    Stevens Defense Academy LLC

    First one of your videos I ever watched… detected a very distinct leftist coloring to the information.  Thanks but no thanks.  I'll look for a more neutral information source.

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    Manuel Muller

    Private systems are always more effective in controlling costs
    Before telling what I'm going to say you should know that east dictators don't like healthcare system that not controlled by government.Ill persons that have less fear from arrest are dangerous. They shoild die soon
    If a country like US have private system they will be forced to allow it in their countries, too. They can create some insurance companies in US that pay higher to make this system fail.

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    @CrashCourse I can't find the economics subject under playlists on your home page. I have to google it separately to find it. Just a friendly notification keep up the great work!!!!

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    Tiger Tiger

    Man.., I can not believe that a supposed “first world” country like the US.. or as the US claims to be…, doesn’t have government paid universal health care system.., that is paid for by ya taxes…, it works.. its simple, easy…
    The US seems to be very backward on so many of these basic subjects…

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    Tiger Tiger

    I imagine it’s partly cultural re the demand for a free market and “small government”.., but also as these guys point out the US is a big place.., made up of far too many individual states to be simple n workable… esp. when these states are fighting amongst each other…

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    Jew Shirls

    The day that politicians like Paul Ryan and Mitch McConnell give up their Cadillac health plans that they receive on the taxpayer dime is the day I will start to listen to them, same goes for rich conservative think tank workers and pastors with special tax exemptions at the public's expense.

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    Plus, much the US population is eating large amounts of processed, unhealthy foods which is increasing obesity, metabolic syndrome, and heart disease. We need to have regulations on food being sold! High fructose syrup should be banned. (my opinion, sorry if you don't like it)

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    If you look at the UK health system, even the doctors at the NHS know it’s broken, there have been numerous large protests. Socialised health care does not provide incentive for doctors or health care workers to work or get into those fields. Why would you work a job as a doctor when you could make the same doing an easier higher paying job. There has been a large number of vacancies at the NHS because people are quitting everywhere due to lack of incentive and overload of stress from the lack of a work force. Also it should be treated like a free market. This will allow competition from various different private health care providers and to stay competitive and drive prices down. For the US universal health care will drive up the massive debt even and probably cause more problems for the working class than a more private health care system created. Even California, one of the most democratic and socialist municipalities has refused to pass a universal health care plan due to the fact that it will double government debt. Universal Health Care is not a right and should not be treated like one. If we treat it as a commodity and a good we will be able to continue to lower prices as competition between private companies increases.

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    DeNeice Kenehan

    Guess what? Good news! We can have Medicare for All simply if Congress legislates it. We can afford it …. because the United States government is monetarily sovereign and thus can never run out of the currency it issues. The government “pays for” anything that Congress appropriates by crediting accounts digitally. That’s how trillions go to wars, and why they really are not concerned about billionaire tax cuts. It’s just keyboard strokes and digits.

    It’s not run like a household, state or local budget …. we cannot make currency! The feds can. Since Nixon.

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    John Michael

    too worried about pissing off people from one side or another to actual state the pros and cons of each system like obamacare. Tell us the money side!

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    Araceli Espinoza

    What's the difference between individual health care and employer healthcare? And what would happen if you lose your healthcare insurance from your employer? Do you have to take health insurance from an individual plan?

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    America = worse outcomes.. highest costs.. bankruptcies.. uninsured.. a real shithole country..
    Medicare For ALL Single Payer.. best choice.. and Progressives are forcing it to happen thank god..

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    DIRTY T.

    Let's be real, when people go to school to become a healthcare worker, it isn't JUST because they want to "help out" their fellow man…..Rather it is ALSO because they want to live a "comfortable lifestyle" and take part in the "American Dream"…..I mean think about it, who wants to deal with potential exposure to all kinds of air borne pathogens JUST our of charity??? Not many I would say.

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    We don’t have insurance anymore because Obamacare drove our insurance so high we couldn’t afford it! Thanks Obamacare! Not!

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    Down to Earth

    This video only goes about half way to any actual truth of the matter but it does make some good points as well. They seriously glossed over how much of it is in fact taxpayer funded and completely ignored alopathic deaths and the fact doctors actually heal almost nobody, ever ? They simply cover up most underlying symptoms of the real issues going on. But it does point out the many fallacies it is all based on today.

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    Rudrangshu Ghosh

    Well, why can't the insurance companies form a consortium and collectively bargain with the hospitals?

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    If every person OWNED all things, then there’d be equal wealth worldwide, and then medical care, food, shelter, clothing, transportation and EVERYTHING would be FREE because the PROFIT SYSTEM, called capitalism aka wage SLAVERY, wouldn’t and couldn’t exist! When workers have a small income they can’t afford health insurance, so then when they get sick and hospitals have to care for them, they can’t recoup their money spent. When every person has the exact same wealth as everyone else, no one has to PAY for meds/hospital care, etc because the big corporations can’t say “if you want MY medicines, etc, you have to get a JOB so you’ll have money to BUY it from me, and if you can’t get enough money no matter how hard and long you work, you can’t have ANY medicines, hospitalization or ANYTHING!” This whole Problem is caused by the WAGE SYSTEM, called CAPITALISM: work for a small wage or starve! So over 36MILLION people starve to DEATH every year! Capitalism is when a FEW RICH people OWN EVERYTHING and try to”create jobs” for some but never enough for everyone on EARTH the majority always struggle and millions die! Capitalism IS PURE SLAVERY! “You can take a slave out of the field and put him in an office he’s STILL A SLAVE, even with a college degree!” Colleges teach slavery! When USA ends wage slavery, and when all people own everything then WE’LL END WORLD POVERTY! Because only a few rich countries created many jobs, such as the huge INSURANCE companies of all types which then forced their employees to deny it to those with no money or “pre-existing conditions” who simply DIE worldwide! That’s most people on earth, they get sick and DIE, mostly because USA is still FORCING all nations into slavery by starting wars, assassinations, teaching torture and so many horrible murders and disappearances etc, which is clearly shown in “Rogue State” by Wm Blum, and many others like Noam Chomsky, Michael Parenti, John Perkins, Gerry Spence and many more at Third World Traveler excerpts. I know there (probably) won’t be an announcement that we’re going to end capitalism, but we can start telling people they all need a GUARANTEED RESIDUAL INCOME!

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    Joseph Zus

    Why are you acting like it's the individual wanting tests? The doctors recommend tests and patients go along with it because the doctor knows what they're doing, right?

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    Walter Hartman

    Are you people out of your minds? Have you completely been sucked into the profit-mongering and control-based faulty medicine that is provided by the Rockefeller Foundation that doesn't care if you live or die and makes money from you being sick? Do you know anything about banking influences and control on medicine and natural or preventative medicine that provides more than everything you need for everything except triage and emergencies? Why get sick in the first place? And when you do, they last place you want to go is to an American doctors who is complicit with the AMA and pharmeceutical companies. If you pracitce Traditonal Chinese Medicine, meditate, do things to strengthen your mind, body, and spirit such as yoga or tai chi, eat well, and pay attention to stress, toxins, intoxicants, and lifestyle habits you'll get sick much and won't need this phony system which made a point of pushing out natural medicine in the early 1900's. Check your history, step out of the matrix, do some research outside of what has been provided for you, and find ways of taking care of yourself that doesn't involve intervention which will make you more sick. I've diverted many surgeries and procedures and taught countless people how to do the same. The healer is within.

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    Rusty yB

    I aggressively negotiate. $50 for leg MRI. $1000 Sinuplasty with three nights in a private hospital room. $2000 for ACL repair with 5 nights in a shared hospital room. Subsequent to both surgeries check-ups with the surgeon were free.

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    Jonah Barnes

    Astounding. You found economists who understand less about economics than my 8-year-old running a lemonade stand. This isn't economics; this is political advocacy.

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    Crystal K

    One third of my household income goes to healthcare. We could sure use that third to save for I don’t know…a HOUSE!! And people wondering why young couples can’t get ahead 🤕

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    Lord Escanor

    Someone with epilepsy pissed them off so much that they're making their videos using a flickering light effect on several images. Y'know.

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    Christine Ramsey

    I don't think that most people overconsume health care. If anything, we have a problem in America of underconsuming health care. Unnecessary tests should be discouraged, but diagnostic tests are valuable and can save lives. Doctors should be the ones to decide which tests and procedures are necessary, and that should not be dictated by the patient's ability to pay. Wastefulness seems to be on the part of providers and insurers, not patients. Putting up barriers to care is not a good idea, because health care has positive externalities. You WANT people to consume it when they need it.

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    Lazy explanation of the ACA. The law also expanded Medicaid, ban max out of pocket benefit caps for plans, mandate no cost share preventive care, mandate all exchange plans cover 10 essential health benefits, etc.

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    david abe

    I felt like this didn't answer anything, or even look at much… Honestly it felt bias in that you found nothing wrong with Obamacare… yet every democrat has run off replacing it since 2016… Why change such a good thing.

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    "mandates use of electronic record keeping" Are you telling me some medical business uses paper for that?

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    Gregory Review

    Why do they NOT consider diversity and homogeneous as a factor?
    Cultural difference?

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    RIDICULOUS and inadequate explanation of Obamacare. Y'all made this in 2016…?!?!?! And Pa-LENTY of things to say about how atrocious it turned out to be. Healthy people, who aren't scared to be fined for not having insurance, didn't opt in like they were expected to.
    That's the FLAW IN THE PLAN!
    Well gee golly gosh! 💩💩💩

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    Prarthana Khot

    Where can I find more information about this topic? Especially healthcare in the USA? Please help me out.

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    John M. Chew

    If the public provided service doesn't include dental and vision, then this places an added financial burden on every individual. You have to pay high taxes, and then you still have to pay out of pocket for dental and vision. How do people live and eat if 60% of their income goes just to healthcare?

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    great USA can not be compared with UK , France and Canada

    Your report is a highly biased and misled , it does not reflect the health economic status because of the no scarcity of resources and the high tech high touch .

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    Matthew Prall

    These people are socialists. I have actually lived in Canada. My fil had a heart attack. He waited in the hospital for 2 weeks on a waiting list to get the stint surgery. The same surgery that would have been performed on him within 24 hours of his heart attack. Why don’t you actually talk to some Canadians that have waited years to get hip and knee replacements. Socialist medicine will collapse our economy.

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    Derek Anselmo

    To say that provider reimbursements are the main factor that makes healthcare more costly in the US vs other country is a blatant lie that really shows the political bias of this channel

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    Todd Adams

    You speak REALLLLYYY SLOWWWLY. Please consider upping your wpm speaking rate. People are able to listen to must faster than you are speaking.

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    More emphasis needs to be placed on the fact that 60% or more of healthcare costs in the United States are due to preventable illnesses caused by personal lifestyle choices.

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