April 14, 2019 - Real Coffe - Scott Adams
20:12
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| Hey everybody! | |
| This is a single topic periscope. | |
| I thought I would hop on here to Slow News Weekend and give you my plan for a capitalist, capitalist version of a health care plan. | |
| Now, here's the first thing you need to know about this. | |
| I don't really know anything about health care. | |
| But neither do you. And that's point number one. | |
| But I'm trying to learn as much as I can. | |
| One of the ways I'm going to learn is I'm going to toss out some ideas, I'm going to get some reaction, and maybe we'll all learn something in the process. | |
| So what you're going to see is not necessarily a good idea. | |
| But it will make you think differently about it. | |
| It will expand the way you're thinking about the topic. | |
| And it will probably educate us all in the process when people tell me why this would or would not work. | |
| Now, one of the things that most of you have been following me on Periscope know is that I'm unusually good at explaining things in simple ways. | |
| And when you have this sort of superpower, you have the Spider-Man problem. | |
| The Spider-Man problem Is that with great power comes great responsibility. | |
| And as funny as that sounds, it's actually literally true. | |
| We live in a world in which the people who have the ability to fix problems are the ones who do it. | |
| Because they can, and because they feel the responsibility to do it. | |
| They're the only ones who can. | |
| So if part of the healthcare dilemma Is that the public doesn't understand it well. | |
| And I'm really good at explaining things. | |
| I thought, well, maybe I'll just jump in, see if I can make any difference. | |
| I'll try to explain it to you, at least as best I can. | |
| And maybe we can all crawl forward on this at the same time. | |
| Alright, so the first question I have is just to make you think a little differently about the cost. | |
| I've heard, for example, if you listen to Fox News, they'll tell you that the cost of universal healthcare would be something like $32 trillion over, I don't know, 10 years or whatever. | |
| If you talk to the people on the left, Bernie, you'll say, well, close to free. | |
| Now, $32 trillion and something closer to free is not the same movie. | |
| So there's something going on here with how people are explaining to you the problem. | |
| There's a big problem. | |
| If you can't tell the difference between, well, it might be one trillion, but, you know, spread over a lot of people, it's worth it. | |
| It's close to free. | |
| Or $32 trillion and it will destroy the entire economy of the planet Earth. | |
| Not the same movie. | |
| Now let me drill into this a little bit more. | |
| My understanding, and I'll ask you to fact check me this, is that nobody in this country is denied healthcare. | |
| If you have some problem that requires an emergency room visit or a hospital stay, my understanding is that that will be provided to you. | |
| It's just that if you can't pay, you don't. | |
| So we're not really talking about covering more people, at least for the expensive stuff. | |
| And the vast majority of the expense is for hospitalization, emergency room, you know, the serious stuff. | |
| It's not for the, you know, the sprained ankle kind of stuff. | |
| So given that all of that is actually being paid for now, who can explain to me why it would cost more to do exactly the same thing we're already doing? | |
| Now that should hurt your head If you've been listening to the press tell you that it's impossible to pay for universal healthcare, think about the fact that we already have it. | |
| What we don't have is universal healthcare insurance. | |
| We actually have universal healthcare. | |
| So why would it cost more to have what we already have? | |
| So really the first thing you need to know is that we're talking about where the money is. | |
| We're not necessarily talking about whether you need more of it. | |
| Because we're already paying for all the things that anybody is proposing, we pay for. | |
| Now I'm exaggerating a little because the routine doctor visits, etc. | |
| would not be, you know, maybe people would just skip them. | |
| And now they would go and have a routine visit when before they would not. | |
| But I ask you this. | |
| Do those routine visits prevent The kind of hospitalization emergency room visits that actually cost all of us more. | |
| Because all of that's being absorbed in people's private insurance, absorbed in the government's cost, comes out new taxes. | |
| Somebody's paying for it, and it's always the public. | |
| Ultimately, it's always the public. | |
| So given that the internet is starting to absorb a lot of the routine doctor visit stuff, you can literally, if you have a smartphone or even a friend who has a smartphone, you can just sort of look up what you have. | |
| You can use my startup's service, Interface by OneHub is the name of the app, and you can contact any kind of expert on there, and the expert will put a price, and you just charge, pay with your credit card. | |
| So you could have a doctor. | |
| If you're a little more concerned, then you can make yourself satisfied by looking at the internet yourself, but you don't have healthcare, You can just pick up your phone, download the app, interface by Wendhub, and we're not the only ones who do this. | |
| There are other telemarketing services, and contact a doctor and say, look at this, do you think I need to go to the emergency room? | |
| So the low end is sort of taking care of itself to a large extent, right? | |
| So the real expense is in the stuff we're already paying for. | |
| So now ask yourself, Do you feel that you've been duped? | |
| Because most of you have been told it's going to cost you something in the many trillions of dollars to have universal health care when we already have it. | |
| We already have it. | |
| So if that's shocking you, like you're thinking, well, wait a minute, that can't be true. | |
| Why are we even talking about it if we already have it? | |
| It's because people conflate the insurance with the actual service, the service we're paying for. | |
| It's already there. It's already built into your costs, right? | |
| So the first thing to know is that you've probably been seriously lied to no matter what source you're looking at for this topic. | |
| You probably have been so amazingly duped about what's going on that you have no idea what the source of the problem even is. | |
| I would say that would describe most of the public. | |
| Now, why is the public so ignorant? | |
| Well, let me throw out a suggestion. | |
| The normal way that the government should work is that the government comes up with ideas and plans and policies. | |
| The press reports on them. | |
| The public decides whether they're persuaded what they like or what they don't like. | |
| And then they feed that back to the government in the forms of voting, etc., polls and voting. | |
| And so this process... | |
| It has to work in order for anything to get done productively. | |
| But the problem is that the press, at least the TV press, and it's probably true of press in general, wherever it is, is largely owned by the pharmaceutical companies. | |
| You can see that for yourself. | |
| Just turn on CNN, turn on Fox News. | |
| The pharmaceutical companies are the primary big-dollar sponsors for all of them. | |
| So can the press act independently if they had any opinions that were counter to what the pharmaceutical industry wanted? | |
| Well, it would be darn hard. | |
| So we probably have a business model situation in which the normal way that things work can't work. | |
| So you have to probably depend on people like me who do not depend on pharmaceutical ads To maybe get you past the fact that the business model is designed to keep you uninformed. | |
| Certainly about the pharmaceutical end of it, anyway. | |
| So let me toss out an idea, a few ideas, and they're just to chew on. | |
| I'm not going to say that these are great ideas, but just chew on for a while. | |
| Suppose you proposed a healthcare policy or set of policies, That we're entirely aimed at making sure that the market works efficiently. | |
| So the good market efficiency is what has given us everything good in life. | |
| So why not do more of that in healthcare? | |
| And the reason that you can't do more of it is because healthcare is what I call a confusopoly. | |
| Now that's a term that I invented years ago. | |
| And it has its own Wikipedia page, and actual professional economists use that term now. | |
| So it's part of the literature. | |
| If you Google Confusopoly, you'll see it used, and I'm the one who invented it. | |
| Now, what that is, is an industry that confuses the consumers to the point where the consumers can't shop by price. | |
| Examples of this are your cell phone company. | |
| If you try to compare two cell phone services, you almost can't, well not almost, you really can't do it because one has rollover minutes and the other doesn't, one has a family plan, one has, you know, they're leasing this or you're paying for this, you need to insure this. | |
| It's so confusing that any one of those options can't reasonably be compared to the other. | |
| So everybody gets in business because the consumer just says, I saw a commercial, I'll get this one. | |
| So they all stay in business. | |
| If they had to compete by price, because their products are presumably so similar, now that coverage is pretty much everywhere, the products are really similar. | |
| If they had to compete by price, they would all go into business. | |
| Because everybody would chase the lowest price until the price went down to the cost of production, and then there's no profit margin. | |
| So cell phone companies are a confusopoly. | |
| Insurance companies are largely confusopolies. | |
| You can't really even tell what's covered. | |
| It's hard for you as a consumer to really compare it to another coverage. | |
| You really can't. | |
| So salespeople have an advantage, and if you trust the salesperson or your insurance broker, you say, well, all right, you seem like a nice person. | |
| If you say, that's the insurance I should have, I can't tell. | |
| So the other confusopoly is everything in the healthcare industry. | |
| Consumers cannot tell what anything costs. | |
| It's hidden from them usually until they get a bill, such as a hospital bill, for example. | |
| And even then, they don't read it. | |
| They don't care. It doesn't matter because they have insurance. | |
| And the insurance company is going to pay for it. | |
| So how could you fix that? | |
| Imagine if the government said, pass the fallen laws. | |
| And just brainstorming here. | |
| Suppose the government said the healthcare industry must have price transparency, and it must be easy to search on Google. | |
| Imagine, for example, that as a consumer, you could tell that if you just drove for an extra hour, you could get your MRI for 25% less. | |
| Suppose you knew that to be true. | |
| Would you do it? No, because the insurance is going to pay it anyway, so you just go to your local one. | |
| But, suppose you also passed a law that says that all healthcare insurers have to offer a discount for any consumers who find a bargain. | |
| So they might say, for example, we'll pay for an MRI up to this cost. | |
| If you can get it cheaper, we'll split it with you. | |
| Because the insurance company saves money, and the consumer gets a discount, and they get some of that discount. | |
| They could actually make money by getting an MRI. The consumer could actually make a profit. | |
| Now, what would that do to the price of MRIs? | |
| In the long run, it would, of course, drive them down. | |
| Because there would be enough people who would be willing to drive that the local one's going to have to lower its price. | |
| Now, you say to yourself, but wait, you don't want the government micromanaging. | |
| How big must this discount be? | |
| Here's the great thing. | |
| Whatever they want. | |
| So one company, one insurer might say, I'm only going to give you 1% of whatever you save by shopping. | |
| Another might say, we'll give you half. | |
| Another might say, we'll give you 75% of it, because we still make money. | |
| It wouldn't matter what they offer. | |
| Because this too would be transparent. | |
| So you as a consumer could say, why would I have a health insurer that's only going to give me a 1% rebate for shopping for lower prices when there's another one that will give me 75%? | |
| Of course, I'm going to change my insurance company. | |
| So as long as you have price transparency, both in the insurer and in the end product, then the consumer is empowered to To put in the extra work to find lower prices and to make some choices about, well, you know, this is the A treatment, but I'm going to try the B treatment first, just to see if it works. | |
| All right? Then third, imagine if the government said that, I'm not sure what policies they would need to change, maybe none, but suppose the government promoted consumers selling their own, only their own, Healthcare data. So let's say the government said, let's make a market for your healthcare data. | |
| And I'm talking about the stuff you get from a monitor, from a Fitbit, something you would get from sensors that you could put on your phone, something you would get from keeping a log, for example, of what you eat or how you exercise. | |
| So you say, look, anybody who wants to can just get an app and And start collecting their health information as much as they want, or as little as they want, because each subset will also have a market. | |
| I could just sell my blood pressure and diet. | |
| It's just the only two things I sell, for example. | |
| So you make a market in it, and this market might be paid for by the insurers. | |
| Because they might say, you know, I want that data and I want people who are tracking that data because they're good to insure. | |
| People who are tracking their data are probably going to be good customers if you're an insurance company. | |
| So I would think that these three changes would in time solve all of healthcare. | |
| Because remember, I think there are somewhere between 14% and 18% who don't have healthcare insurance in this country. | |
| That's not a giant number, 14%, 18%. | |
| And the difference is how good the economy is. | |
| So a capitalist plan would be something like this. | |
| Let's take that 14% who don't have healthcare and see if we can shrink it by improving the economy. | |
| Get that down to maybe 12% just by having a good economy, a capitalist plan. | |
| For that last 12%, that's only an insurance cost. | |
| Because most of those people are actually getting healthcare coverage, they're just going to emergency rooms and not paying the bill. | |
| But somebody's paying for that bill, so the money exists in the system if you can make the system more efficient. | |
| And the way you would make it more efficient is by government regulations that require price transparency. | |
| So consumers could shop, but the health insurance companies would have to offer a rebate. | |
| So if the consumer shops, the consumer actually gets some of that money. | |
| Any percentage that they want to, because their costs will be transparent as well, so the consumer can say, well, I'll go to an insurance company that gives me a bigger rebate, because I'll shop all day to save money. | |
| And then create a market that's legitimate and has some standards for people who want to sell their healthcare. | |
| Now, this is not just because you could make money at it. | |
| It's because the healthcare industry would get better The more information they have about people's lifestyle and how that affects their health outcomes, the more data they have, the lower healthcare costs should be because you'll be able to catch things sooner. | |
| You'll be able to tell people to avoid behaviors that you didn't know were dangerous before, but now you've learned because you have all this data. | |
| All right. This is my set of ideas to think about today. | |
| The big problem is that the healthcare industry is a confusopoly. | |
| If the government tries to fix it with detailed stuff, it's too hard. | |
| And they're never going to be able to do it because of the business model of the press and the fact that their advertisers do put a set of inhibiting forces upon them. | |
| So, If you want any kind of big healthcare fix, it's going to have to be simple. | |
| Somebody said it just at the very moment I was going to say it. | |
| A comment came by that said, keep it simple as stupid. | |
| Yes. What I've described, I think, would qualify as super simple. | |
| Now, it would be hard to get the transparency, etc., but it's easy to explain to the public. | |
| It's easy to know what that is, and it's easy to know if you're doing it right. | |
| The execution will take some time. | |
| You'd have to iterate it. | |
| You'd have to work on it to get it to a high quality, but you could do that. | |
| It's just normal iteration and improvement. | |
| Humans do that really well. | |
| But everything about this, I don't think anybody was confused by it. | |
| And I think you would agree that this would unlock the confusopoly, turn it into a transparent market, market forces would do what they do, and then that little 12 or 14 percent who don't have insurance, the economy will not be damaged by, you know, stepping it up and making it possible for them to get insurance too. | |
| So, That is all I have for today. | |
| I'll keep it short and send me your comments in the Twitter feed where you'll see this. | |
| You can add your comments there and then I'll take a look at those later. |
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