327 - Choices, costs, and challenges in US healthcare: insurance, drug pricing, & potential reforms

There's a super long episode on The Drive going deep into the mechanics and economics of the US healthcare system, could be a useful addition to the conversation here: ▶ this video

The rises in health care costs were happening long before Obamacare, and if anything Obamacare reduced the rate of rises or kept them at the same level. We have chosen this to have high access, high quality care, while also choosing to reduce health with the way we subsidize our food system and force indolent lifestyle with car-dependent urban planning. The best primer on the choices that make our healthcare expensive, and where the money goes, are in this video: ▶ this video Unfortunately our national discussion of health care is not centered on the reality of the discussion, and is several levels of technical depth too shallow for us to have a public discussion that could reduce costs without reducing the care level for many peopl.

There are very very serious financial problems with going down this route. Private insurance pays for a lot of Medicare, because Medicare reimbursement rates do not cover the costs of Medicare patients in many parts of the country. One of the better sources of information I have seen on this is actually a YouTube video, something I don't normally recommend, but getting a wholistic viewpoint is somewhat difficult otherwise: ▶ this video We could increase the medicare contribution cap (samething like only the first $175k of income has medicare tax applied to it), but I'm not sure that's going to fill the massive gap. Perhaps increasing the rate would also work. There could be some good things about this process, I just want to bring up that it's not a magic bullet because we will run into access problems unless we also solve the funding side of things. And when there are access problems, the people who lose access will be those with the least to pay.

> For anyone looking for a nuanced perspective on this, I highly recommend Peter Attia's interview with Saum Sutaria (McKinsey's formed healthcare lead) The taste I got of it (introduction bit) ▶ this video A definition of insurance that doesn't seem to understand how randomness can be upon the group instead of the individual. A person in his situation can't be so grossly misunderstanding pooling risk over a population. I've skipped here and there among the multiple videos to get a better feeling of the whole interview, but to be blunt that perfectly fit into the stereotype of a guy coming from McKinsey.