True Anon Truth Feed - Episode 14: Sicko Mode
Aired: 2019-09-28
Duration: 01:39:02


=== Crazy Accents and Smoking (01:02) ===

[00:00:00]  I really hate how in the in Europe, they have the like they make you put like, this is what your lungs look like before you die, on smoking packages, which is bullshit.
[00:00:10]  They're like your dick won't work if you blast enough cigs.
[00:00:13]  Here's the thing, you won't even get like.
[00:00:15]  They say that like you'll get erectile dysfunction.
[00:00:17]  Do they say that?
[00:00:18]  Yeah, but the problem, do they say that the problem is, if I didn't, or let's say, if you didn't to the European, if you didn't smoke cigarettes, if Italians didn't smoke, if Frenchmen didn't smoke, they would never get to use their dicks.
[00:00:31]  Because smoking looks so cool and exactly, it's such a good way to talk to someone outside of a bar or something like oh, do you have a cigar, do you have a galois?
[00:00:42]  And she's like yeah, that's such a crazy accent.
[00:00:46]  Um and, and sure you get ed, but you can still, you know, get in there.
[00:00:53]  Um, for the time being, for the time being yeah, all the thing is about smoking is, it's not that bad for you until you're really old?
[00:01:00]  Um, it doesn't harm you?

=== Risk Pools and Healthcare Costs (15:49) ===

[00:01:02]  I don't think that's true.
[00:01:04]  But I have a question, brace yeah, dr Brace.
[00:01:08]  Um, what kind of cigarettes did they have in the Middle East?
[00:01:10]  Galois really yeah, Galois.
[00:01:13]  Well, the Arden uh, which are Armenian cigarettes, ultralights Arden uh, Chinese cigarettes which were rough uh, and if you were lucky and go to go to the store, you got Galois, blue or red huh uh, those are the ones I liked, but you didn't.
[00:01:28]  You didn't get those really, you just got Ardens um, but yeah, it's like I told everyone out there i'm like, don't listen to the Zionist lies.
[00:01:37]  Cigs are good for you, they make you look cool, they give you strength.
[00:01:41]  It's like uh, you like both the Pink Panther but also Jason Bourne.
[00:01:47]  Didn't you say that Isis had like Coca-cola?
[00:01:49]  Yeah, it's Snickers and stuff which is like yeah, who's given it to them?
[00:01:54]  Obviously the U.s government has given it to them.
[00:01:57]  Um, welcome once more to true and all.
[00:02:30]  Welcome to the death panel.
[00:02:34]  Ours is a panel deciding whether your grandmother dies because her surgery to get bigger titties is too expensive.
[00:02:43]  Wait, but they're kind of our, I mean, I know that was the Republican like scare point about the ACA, but they're like kind of our death panels.
[00:02:50]  Private insurance companies are death panels.
[00:02:52]  Yes, exactly.
[00:02:54]  State legislatures that cut funding for Medicaid are death panels.
[00:02:57]  This is what like bothers me.
[00:02:59]  It really gets my goat about the Republicans.
[00:03:02]  They're so much better at meming this shit.
[00:03:05]  Yeah.
[00:03:05]  And the fucking spineless, bloodless Democrats.
[00:03:08]  This is what I was saying.
[00:03:09]  Remember what I said about spirit cooking?
[00:03:11]  Yes.
[00:03:12]  How did we not latch on to spirit cooking as like a meme for elite decadence?
[00:03:17]  It's the most horrifying image.
[00:03:18]  I'm not sure if it's true.
[00:03:19]  Death panels and what they were saying wasn't true.
[00:03:22]  I mean, could you imagine Ted Liu coming up with something that's like fucking advanced?
[00:03:26]  The posting Congressman?
[00:03:27]  Yeah.
[00:03:28]  Him being like, you know, whatever Democrat version of death panels are.
[00:03:32]  I think that's what Christman called him.
[00:03:33]  The post-post and steal Congress from the boys.
[00:03:36]  No, he hit up Anchor when we were unionizing.
[00:03:38]  It was like, can I do anything to help?
[00:03:39]  And that email was left unanswered.
[00:03:42]  You didn't want him to post about it?
[00:03:43]  Absolutely not.
[00:03:44]  No.
[00:03:46]  We are here deep in the bowels of a secret medical research center trying to make Liz less mean to me.
[00:03:54]  We are joined today by doctor with both an MD and PhD, Timothy Faust.
[00:04:04]  I'm happy to be a pedo hunter now.
[00:04:06]  Yes.
[00:04:07]  I got my armist training and I can kill a man.
[00:04:09]  I can kill a pedo from 400 feet away.
[00:04:11]  That's what PhD stands for, pedo hunting dude.
[00:04:16]  And I'm Liz.
[00:04:18]  Hello.
[00:04:18]  And who are you?
[00:04:19]  Oh, me?
[00:04:21]  I am, you know, I am actually related distantly to one of the founders of Aetna Insurance.
[00:04:27]  My name is Brace Belden.
[00:04:29]  Distantly related.
[00:04:30]  I don't have any of the money.
[00:04:32]  This is a unique and special episode of True Anon.
[00:04:37]  Also, Young Chomsky, our producer, insists on also being included in this.
[00:04:42]  Even though it's not the credits technically, and I'm just doing him a favor by doing it.
[00:04:46]  It's the opening credits.
[00:04:47]  Debatable.
[00:04:48]  Okay, so this is an unusual episode for us, but I think a necessary one.
[00:04:53]  Absolutely.
[00:04:55]  So yeah, this is a bit of a detour, but we are in the beginning thick of it.
[00:05:03]  Starting to be in the thick of it of the Democratic primary.
[00:05:06]  Things are heating up.
[00:05:09]  And we will definitely be back to our regular scheduled programming of Elite Pedo Hunting very soon.
[00:05:18]  But we had friend of the pod, Tim Faust, is in town on book tour for his book, Health Justice Now.
[00:05:29]  Single payer and what comes next.
[00:05:31]  And so we thought, what a perfect opportunity to have him in studio in the Black Lodge of Truanon headquarters to talk to us about this funny business of healthcare, but more specifically, and this is kind of how we wanted to frame the conversation, why don't we have universal healthcare?
[00:05:54]  Because I'm always saying on the podcast, and I've said it on other podcasts, that, you know, one thing that we kind of want to keep hammering home to our listeners is that these people that we're profiling when we talk about Jeffrey Epstein and his comrades in arms, in keto arms, in decadent elite, disgusting bourgeois arms, are the ruling class of America.
[00:06:21]  And these are not just the people who are, you know, sacrificing children in blood rights to Moloch, allegedly, but also the ones that are not giving you universal health care.
[00:06:36]  And so we kind of want to talk about why that is and what we are kind of up against as we look towards the 2020 election, as we look towards a greater goal of what Tim calls health justice and Medicare for all.
[00:06:55]  And also, of course, electing Comrade Bernie Sanders and the arresting everyone else who's running.
[00:07:03]  Yes, and the abolition of the proletariat.
[00:07:05]  Yes.
[00:07:06]  So hi, hello.
[00:07:08]  Hello.
[00:07:08]  I'm happy to be here.
[00:07:09]  That was very long-winded.
[00:07:10]  Sorry, guys.
[00:07:11]  It's all right.
[00:07:12]  Your voice is music to my ears.
[00:07:15]  It has perked me up and led me to ask the question, Tim, what is a doctor?
[00:07:21]  A doctor is a kind of mammal.
[00:07:25]  Is that a real question?
[00:07:26]  No.
[00:07:28]  No, I want to make clear before we start on this.
[00:07:30]  I am like, I mostly know about stuff like Jeffrey Epstein and healthcare.
[00:07:37]  For me, I have no health care.
[00:07:40]  I have what they call Medi-Cal.
[00:07:42]  So I have technically free healthcare, but it's that kind of healthcare that, in my case, actually put me, made me have to go to the hospital because it's so bad.
[00:07:52]  So Liz here is actually a nerd, and I feel like you probably should ask the first question.
[00:07:57]  How should we start this?
[00:07:58]  I want to talk about kind of the different forces that we're up against.
[00:08:02]  A lot of people talk about the insurance companies.
[00:08:05]  A lot of people talk about their lobbying arms in Congress.
[00:08:10]  A lot of people talk about the hospital monopolies.
[00:08:15]  Big Pharma is a name that gets thrown around a lot.
[00:08:19]  And medical device companies, of course.
[00:08:22]  So the healthcare industry in general is a massive part of our economy.
[00:08:26]  And so the idea of basically attempting to nationalize it, because that's really what we're talking about, is a huge endeavor.
[00:08:34]  We're attempting to nationalize the payer side right now.
[00:08:36]  Yes.
[00:08:37]  You've got two components, the payers and the providers.
[00:08:39]  Providers are things like DMEs, hospitals, mom-and-pop doctors, pharma companies, et cetera.
[00:08:45]  Those folks still exist under a single-payer model.
[00:08:48]  What we're attempting to nationalize is the payer side, the provision of insurance.
[00:08:52]  So your insurance companies and, well, that's really it, your insurance companies.
[00:08:55]  Right.
[00:08:56]  And so you mentioned before that we've got all these kinds of, we've got this rogues gallery of folks who together are why we don't have national insurance or national healthcare in the U.S. That's because, I mean, unlike other industries, I think, or other sectors of the economy, healthcare is one about literally who is permitted and who to live and who was compelled to die, who was allowed to be safe in their own bodies, whose suffering matters.
[00:09:22]  And it's rationed entirely right now by private profitability.
[00:09:26]  Things like Medicare and Medicaid exist not because we're benevolent actors, but because we're siphoning off the folks who are the least profitable to take care of and putting them on the public time so that private companies can make a profit.
[00:09:37]  And so you've got these, you've got industry upon industry upon industry that are layered together like brambles, choking out the life energy, the spiritual force of millions and millions and millions of Americans whose existence is predicated upon that deep and mass exploitation.
[00:09:53]  So you've got a bunch of concurrent actors who are serving to keep us from the things that we want.
[00:09:58]  And they together are the mass structural reasons that we don't have yet single payer or anything beyond that in the U.S. Because they've all got a shit ton of money.
[00:10:08]  Yeah.
[00:10:08]  And I want to be clear because this is also something that Brace, you're always stressing, and I'm always stressing, that when we talk about these people we're up against, there's no, they're all just Republicans.
[00:10:21]  Yeah.
[00:10:21]  There's no like, and sometimes some Democrats like this is a, you know, this is a ideological choice.
[00:10:30]  Like they're like they're, right?
[00:10:31]  I mean, I think that's what you're going to say.
[00:10:33]  Like they're, they're, we could easily, not easily, but we could definitely have universal health care in America.
[00:10:40]  We have chosen to let poor children die from things rich children don't die from.
[00:10:44]  Yes.
[00:10:44]  Exactly.
[00:10:45]  And I guess what I just want to stress is that like the obstacles are not, are cross-party.
[00:10:53]  Yeah.
[00:10:53]  Oh, no, it's a class thing.
[00:10:55]  It's not like a, it's not like a Democrat-Republican kind of thing.
[00:10:59]  I mean, obviously more Republicans don't want it than Democrats do, but the amount of Democrats that actually want it, you can count on like a fucking three fingers.
[00:11:08]  It's it's yeah, it's definitely like it's it's it's another one of those stunning displays of class solidarity the fact that we can't like if my dick gets broken once again I have to snap it back into place.
[00:11:20]  I can't just go to the doctor and demand that they do that.
[00:11:24]  I have to pay for it, which is absurd.
[00:11:27]  And the doctor would prefer to snap your dick back in place.
[00:11:30]  Absolutely.
[00:11:31]  Go along his or her day of snapping a bunch more dicks back into place, but instead they are compelled to spend all their time or 60% of their time filling out various billing forms to see if you have Medi-Cal or Medi-Cal A or Blue Cross 101.3 or Kaiser Permanente planned Silver Dash Omega or whatever.
[00:11:50]  Yes.
[00:11:50]  And they can't do their job of snapping dicks back into place.
[00:11:53]  Yeah, so I don't, like, who are the major players in the reasons, on the corporate side, on the reasons that we don't have free healthcare?
[00:12:05]  Sure.
[00:12:05]  So the kind of scope of healthcare in the U.S. is divided in two categories, payers and providers.
[00:12:13]  Payers, you've got basically just insurance companies.
[00:12:16]  They provide, they pay for healthcare costs.
[00:12:18]  That's what insurance is.
[00:12:19]  On the provider side, you've got doctors, you've got hospitals, you've got pharma, you've got equipment manufacturers, and you've got, I think, most compellingly to me, the private equity companies that own a shit ton of hospitals and resources in the U.S.
[00:12:36]  So maybe we take those kind of in that order.
[00:12:38]  Yeah, that sounds great.
[00:12:39]  Sweet.
[00:12:40]  So first off, you've got insurance companies.
[00:12:43]  So that's right.
[00:12:45]  Fundamentally, the notion of insurance is a very good idea.
[00:12:48]  Insurance is pretty cool.
[00:12:50]  Private insurance, and especially for-profit insurance, or insurance which results in the profit, is, I think, amoral, or sorry, immoral and fundamentally bad, and also inadequate to the task at hand.
[00:13:02]  So insurance exists because medical costs in general across time and space are always way higher than any individual can afford.
[00:13:10]  You get into a car wreck, you get hit by a train, your dick falls off, whatever.
[00:13:13]  Like it's going to cost a lot more than you can afford to get that fixed.
[00:13:17]  So insurance is the simple concept of us pooling together some money from all of us and using that pool, that risk pool, to pay off healthcare costs when they happen to somebody.
[00:13:27]  The idea is that someday you'll get got, someday your day of tragedy happens, right?
[00:13:32]  Like your car breaks and it swerves in the traffic, you get bombarded with a spare neutron and get cancer or whatever.
[00:13:37]  Like at some point, you're going to get sick.
[00:13:39]  And so you can just kind of pool the money together and we siphon it off when folks need it.
[00:13:43]  Private insurance takes that model and does two things.
[00:13:46]  It fragments that risk pool or that patient base into a bunch of smaller bases, which are then privatized and given to a given insurance company.
[00:13:55]  And it extracts profit and it extracts things like administrative costs and marketing costs and all these other costs that are replicated across every insurer in the space.
[00:14:04]  And insurance companies are fundamentally incapable of both seeking profit and taking care of the sickest people because insuring sick people is not very profitable.
[00:14:15]  A person with hemophilia, an example I use in the book, costs up to a million dollars to insure.
[00:14:20]  So if you're an insurance company, you don't want to insure people with hemophilia.
[00:14:24]  So you do things like restrict access to drugs that treat hemophilia or cut off the doctors who treat the most hemophilia patients because they're your most expensive people to take care of or your most expensive drugs, your most expensive doctors.
[00:14:35]  So you kind of siphon away the things that don't make you money.
[00:14:38]  And like perhaps these things aren't explicitly done for those reasons, but it's the net result.
[00:14:44]  My hypothesis is that insurance companies aren't necessarily malevolent, but they're just deeply incompetent to the task of insuring a full population.
[00:14:52]  And so they carve out these things, which ultimately harm and kill people because they are companies who seek profit.
[00:14:58]  Well, yeah, it's just the nature of the profit-seeking system.
[00:15:02]  It doesn't have a consciousness that it's choosing one way or the other.
[00:15:05]  It's seeking profit, and therefore it will do what it needs to do in order to attain those goals.
[00:15:11]  Right.
[00:15:11]  Yeah, like that's the sole reason it exists.
[00:15:13]  That's the same thing for capitalism.
[00:15:15]  Yeah.
[00:15:16]  But in general, the whole idea is that the bigger the risk pool, the cheaper it is for everyone because you've got all the sick people in with all the healthy people.
[00:15:29]  Right.
[00:15:29]  Like I like I know that, for example, at the UCs at the University of California, they pool like all the different schools.
[00:15:38]  How many are there of them?
[00:15:39]  Like seven maybe?
[00:15:40]  Seven or eight of all the state universities are all pulled together.
[00:15:46]  So you can imagine, and it's all, you know, primarily except for graduate and postgraduate programs, but they're all in the same, you know, and I think faculty is in the same program.
[00:15:57]  But the primary population is going to be 18 to 24, which is by insurance standards overwhelmingly healthy.
[00:16:03]  Yeah, that's your cash chaos.
[00:16:05]  Yeah.
[00:16:05]  Yeah.
[00:16:06]  And so the sheer amount of people and with the age, like it'll keep costs down for everyone.
[00:16:12]  And it's incredible insurance from what I understand for those very reasons.
[00:16:18]  And you want to have a well, you want to have as large a risk pool as possible because that's how you have negotiating leverage with hospitals.
[00:16:25]  Right.
[00:16:25]  Like if we three were together or we four were together form an insurance company that insured just us, we'd be hosed because we would need hospitals way, way more than they would need us.
[00:16:35]  And so they say it's going to cost $14,000 to get your finger snapped back into place or whatever.
[00:16:41]  And we can't say no because we have no leverage against them, right?
[00:16:44]  And so if you have a small customer base, a small risk pool or whatever, you are basically at the mercy of hospitals who are also bad guys.

=== Structural Pressures in Surgery Rates (05:17) ===

[00:16:52]  There's no good guys here except for patients.
[00:16:54]  Patients are good guys.
[00:16:55]  Primary care doctors are good guys.
[00:16:57]  Nurses are extremely good guys.
[00:16:59]  But hospitals, especially big corporate hospitals, are bad guys as well.
[00:17:03]  And sometimes even like the general hospital we have down here, they have done something.
[00:17:07]  You mean Mark Zuckerberg?
[00:17:09]  Yeah, excuse me, Mark Zuckerberg's hospital.
[00:17:10]  You know what's funny about that?
[00:17:12]  Whenever it's bad press, it's called SF General.
[00:17:15]  And whenever it's good press, it's called the Mark Zuckerberg hospital.
[00:17:18]  The whole thing's stupid because I've literally, I've gotten bills, kind of.
[00:17:22]  I've gotten like letters saying that I have to do all this shit from Mark Zuckerberg Hospital.
[00:17:26]  Like, no one wants that.
[00:17:27]  You don't want your name on a bill.
[00:17:30]  Also, his wife works there.
[00:17:31]  Priscilla?
[00:17:32]  Yeah.
[00:17:33]  That's just kidding.
[00:17:35]  I'm sure she's great, allegedly.
[00:17:36]  I fucked her.
[00:17:38]  So that's the insurance company.
[00:17:40]  And then there's, should we talk about pharma?
[00:17:44]  How about hospitals?
[00:17:44]  Because we're right there.
[00:17:45]  Yeah, let's talk about hospitals.
[00:17:47]  I'm trying to remember the order that we were going in.
[00:17:49]  Yeah, let's talk hospitals.
[00:17:51]  Scam pits.
[00:17:54]  Who needs them?
[00:17:55]  DIY or die.
[00:17:57]  Yes.
[00:17:57]  A rock is all you need.
[00:17:58]  A rock and some incense.
[00:18:00]  No.
[00:18:02]  So hospitals come in a wide spectrum of flavors.
[00:18:04]  You've got your massive corporate hospitals like the Cleveland Clinic, and you've got your small, hard-scrabble rural hospitals in rural areas like rural Georgia, for example.
[00:18:13]  And they're not operating the same level.
[00:18:15]  They're not doing the same things.
[00:18:17]  But they all, like ultimately, they are the primary drivers of price in the U.S. Hospitals set prices, basically.
[00:18:25]  And prices are not set based off of costs.
[00:18:28]  Prices are set for entirely arbitrary reasons.
[00:18:30]  I've got some good examples that I like.
[00:18:32]  One is here in California, an appendectomy can range between $1,000 and $180,000 with no bearing upon patient condition or difficulty of appendectomy.
[00:18:43]  It's just based upon arbitrary factors, like how the hospital feels that day, what insurance company the patient has, which doctor is treating the patient, whether it's the doctor or a physician extender who's actually in the operating room.
[00:18:58]  All these arbitrary factors that determine how much a thing costs.
[00:19:01]  But that's why you can't go to a doctor or go to an insurance company and ask, how much is this thing going to cost me?
[00:19:06]  Because nobody knows.
[00:19:08]  It is an alchemical formula that is derived at the time of billing and not a moment before.
[00:19:13]  So it's like magic.
[00:19:14]  It is like magic.
[00:19:15]  It's black magic.
[00:19:16]  Okay.
[00:19:17]  And it's really stupid black magic.
[00:19:19]  Also, like, speaking of appendectomies, like there's a there's this idea of provider-induced demand, which was examined in Vermont in the 70s.
[00:19:29]  It's an interesting example.
[00:19:30]  It focuses on tonsillectomies.
[00:19:33]  A researcher took a bunch of Vermont as a relatively homogeneous state and that counties don't vary too much from each other.
[00:19:41]  One county looks just like the neighboring county as far as like racial distribution, income, sickness, et cetera.
[00:19:48]  So there's no like hot pockets of like extreme sickness or extreme poverty or whatever.
[00:19:51]  It's pretty even across the entire way.
[00:19:53]  So you would presume that a surgery like tonsillectomies would happen at a consistent rate across each county, which ended up not being the case.
[00:20:01]  You had neighboring counties with seven times the tonsillectomy rate of other counties.
[00:20:05]  It turns out tonsillectomies tend to happen when the doctors prescribing them happen to like tonsillectomies.
[00:20:11]  It's based in training.
[00:20:12]  It's based on whether your hospital likes prescribing tonsillectomies or likes doing them.
[00:20:17]  It's based on these entirely like outside factors independent of whether a patient actually needs a tonsillectomy.
[00:20:22]  interesting they like like if it no that's true because some i i mean this is just anecdotal but i mean i know that like there's definitely depending on a doctor's opinion about whether or not a kid actually needs a tonsillectomy which is i mean it it's usually like if you've had strep throat like five or six times as a kid or something like that.
[00:20:45]  And they're like, well, we could do this and that'll stop you getting strep throat.
[00:20:48]  But it's not usually required in order.
[00:20:51]  Do you know what I mean?
[00:20:52]  Like it's basically elective.
[00:20:54]  I've got a great example of that.
[00:20:55]  This took place in New York City in either the 90s or early aughts.
[00:20:58]  I think the early 90s actually.
[00:21:01]  Researchers took a big group of kids, not for pedo reasons, but for medical reasons.
[00:21:05]  Yeah, and so they're safe.
[00:21:07]  Thin line, though.
[00:21:08]  And who had sore throats and brought them to a group of doctors.
[00:21:11]  And about half of the kids were recommended for tonsillectomy.
[00:21:14]  Cool.
[00:21:15]  So they took the remaining half of the kids and brought them back to a panel of doctors, and about half were recommended for tonsillectomy.
[00:21:21]  All right?
[00:21:22]  The remaining kids brought them to a third panel of doctors and about half were recommended for tonsillectomy.
[00:21:26]  It turns out that tonsillectomies just in New York happened to have a 50% recommendation rate, independent of whether or not, like it varied from doctor to doctor to doctor to doctor.
[00:21:34]  It doesn't really have like, there's not like a clear standard for when you prescribe a tonsillectomy and when you don't.
[00:21:40]  And hospitals play a really big role in determining how these things happen.
[00:21:44]  Another study done by the same guy, Dan Wundberg, Don Wundberg, really, really good researcher, looked at doctors who worked both at both the New Haven and Boston area hospitals, Harvard and Yale, and found that their referral rates or their surgery recommendation rates changed based upon what hospital they were working in at that point in time.
[00:22:02]  Hospitals really pressure doctors in both subtle and unsubtle ways to fill every bed that they have at any given time.

=== Hospitals Exploiting Sick Populations (15:02) ===

[00:22:10]  There's this idea called Romer's Law, which is that every hospital bed that is built is going to be filled regardless of actual need.
[00:22:16]  Now, I'm not trying to condemn doctors.
[00:22:18]  Most doctors want to do the right thing.
[00:22:20]  I'm just saying there are structural pressures independent of conscious thought or whatever that really, really affect things like surgery rates and that really affects price.
[00:22:31]  And so that's like a relatively benign example, but it has significant, significant outcomes.
[00:22:35]  So I have a question, because you mentioned the sort of difference between hospitals like the Cleveland Clinic, which is very famous, or we could talk about like Cedars, Sinai, and LA, and say like rural hospitals that are not as perhaps well funded, or not as, you know, maybe not as steeped in either philanthropic donations, or what we'll talk about in a little bit with private equity.
[00:23:01]  And just like how that, because that leads to very disparate outcomes in care, right?
[00:23:07]  Right.
[00:23:08]  Right.
[00:23:09]  So Cleveland Clinic is one of the world's best hospitals if you're rich.
[00:23:14]  You can get a helicopter there and get a gold-plated heart transplant.
[00:23:17]  If you're a Saudi prince, no problem.
[00:23:20]  They've got their own art gallery.
[00:23:21]  Ah, like our good friend MBS, also Epstein's friend, if he needed one, that's where he would go.
[00:23:26]  Absolutely.
[00:23:27]  Wow.
[00:23:28]  Are they really friends?
[00:23:28]  Of course they're friends.
[00:23:29]  Yes.
[00:23:29]  Yeah.
[00:23:30]  Oh, they're friends.
[00:23:31]  He's friends with just every guy.
[00:23:33]  But also there's a photo.
[00:23:34]  I guess there's a photo in his house of them together.
[00:23:36]  Yeah.
[00:23:38]  Every time someone would go to Epstein's house, Epstein would sort of either show them that photo or like prominently display it next.
[00:23:46]  Like he'd be standing in front of it or something like that.
[00:23:49]  Yeah, MBS rocks.
[00:23:50]  I mean, he sucks, but it's...
[00:23:52]  Who was it that...
[00:23:53]  Who was it?
[00:23:54]  Tom...
[00:23:55]  Was it Thomas Friedman?
[00:23:56]  Or was it Kirk?
[00:23:57]  I think it was Friedman.
[00:23:58]  Who was like, oh, he rules now?
[00:23:59]  Yeah, yeah.
[00:24:00]  It was like the woke prince of Saudi Arabia or whatever.
[00:24:03]  Yeah, he is.
[00:24:04]  He is.
[00:24:05]  He's our woke king.
[00:24:07]  I like the Saudi Prince Fail Sons who single-handedly keep the mobile games industry afloat.
[00:24:12]  Yes.
[00:24:13]  I think those guys rule.
[00:24:15]  They're dropping like 86K to get a fancy horse in a game where you just push a single button over and over and over.
[00:24:20]  I know.
[00:24:21]  It's so good.
[00:24:22]  Yeah.
[00:24:22]  That's fantastic.
[00:24:23]  I know.
[00:24:24]  Saudi gamers are probably the most advanced gamers in human history.
[00:24:28]  And definitely in the history of gaming on the Gulf.
[00:24:31]  Just ask Felix.
[00:24:32]  He'd know.
[00:24:33]  Yeah, I'm sure.
[00:24:34]  He practically is one.
[00:24:36]  Okay, back to the Cleveland Clinic.
[00:24:38]  So Cleveland Clinic is one of the best hospitals in the world.
[00:24:42]  And also, coincidentally, it's built in the middle of like a totally bombed out neighborhood in Cleveland where nobody who lives in the area can afford to get care in the hospital.
[00:24:50]  One of the sickest neighborhoods in the state, one of the sickest neighborhoods in Cleveland.
[00:24:55]  And because of the position of the hospital and its real estate cash grabs and its active pursuit of the blight of the surrounding area for its own profit, it's like this literal ivory tower in the middle of a disaster zone of people who've been made poor and made sick for decades and decades and decades.
[00:25:14]  It's like Johns Hopkins too, right?
[00:25:16]  Yep, exactly.
[00:25:17]  Man, I've got a Hopkins story before I go into the rural areas.
[00:25:20]  So Johns Hopkins.
[00:25:22]  The trend over the past 15 years has been closing down, has been to close down rural hospitals and to close down primary care centers and clinics in poor and sick neighborhoods.
[00:25:35]  Simply put, that's because primary care isn't very profitable.
[00:25:38]  Primary care is intimate and it's slow and it takes time.
[00:25:43]  And our billing models of how you pay for care don't take those things into account.
[00:25:47]  You get paid for an appointment and an appointment pays you, let's say, 80 bucks.
[00:25:51]  But some folks need like half an hour to get onto the bed or have a lot of questions or are really sick or are scared or whatever.
[00:25:58]  And they might take half an hour to an hour to like take care of, but you're still getting paid that 80 bucks to take care of them.
[00:26:07]  And that's like not profitable.
[00:26:10]  You can't make a living off of that.
[00:26:12]  So that's why you have, for example, the case now where doctors will see you for 10 minutes.
[00:26:16]  Yeah.
[00:26:17]  That's a big thing.
[00:26:18]  Because now they have the nurses do the work and then the doctor swings in to check the box to get the 80 bucks.
[00:26:24]  The only kind of labor that makes a real difference in population health is not necessarily medical care, but compassionate labor.
[00:26:30]  It's social work.
[00:26:31]  Medical care represents 20% of health outcomes.
[00:26:34]  The rest of it comes from social determinants of health like housing and food.
[00:26:38]  And those are driven more by compassionate labor instead of medical care, regardless.
[00:26:41]  So Hopkins found Hopkins was closing down primary care clinics in poor areas where people who were sick lived because it wasn't, because they were losing money in those areas.
[00:26:53]  These things aren't profitable.
[00:26:54]  And so people would go to the emergency room at Hopkins to get the care they needed because there was no urgent care available.
[00:26:59]  So they'd say, oh, I have a sprained wrist.
[00:27:02]  Oh, I've got my dick snapped in half.
[00:27:04]  Oh, I've got a really sore throat.
[00:27:06]  They had to go to the ER because there was nowhere else to go in that area.
[00:27:10]  So Hopkins goes, oh, now these people are coming to our hospital and filling up our hospital beds.
[00:27:15]  That's time we can't spend doing surgery or getting more like profitable care in there.
[00:27:20]  Let's go ahead and open an urgent care center inside the hospital and then use that to charge hospital rates.
[00:27:26]  Because what building you are in affects what prices are.
[00:27:29]  Another thing that happens is hospitals, or especially PE firms, which I think we'll go into later, will buy up primary care clinics and then charge hospital rates because these are now hospital affiliates.
[00:27:39]  Like prices are entirely fake.
[00:27:42]  You can overnight change how much a basic procedure costs based upon who owns the facility, which the procedure happens.
[00:27:49]  You've also got MRIs.
[00:27:50]  MRIs have a, here, cost five times more than what MRIs cost in Australia, even though it's the literal same machine doing the same procedure.
[00:27:58]  In DC, Sarah Cliff did a piece showing that MRIs, like the literal same MRI machine, the exact same one, in the same hospital, would have a seven-fold cost variance based upon entirely arbitrary factors, like who's paying for it or time of day or whatever.
[00:28:12]  So prices are entirely fake.
[00:28:14]  And this is a thing that hospitals can do because no one is stopping them.
[00:28:18]  Insurance companies are too small and too fragmented to really push back on costs, and hospitals are chasing the profit.
[00:28:26]  But then you've got rural hospitals and primary care centers, which are kind of in a different boat.
[00:28:30]  Rural hospitals are interesting.
[00:28:32]  Rural hospitals tend to serve populations that are sicker, that die sooner, and are poorer, right?
[00:28:37]  That's how we have entirely pulled out of rural America.
[00:28:40]  Hope you live in one of the 25 cities in the U.S.
[00:28:43]  We were talking before the podcast, and I was saying that it's not just in the case of hospitals, but that like we have a massive capital flight issue all throughout rural America that no one is really looking at.
[00:28:57]  And you're saying there's like no banks in a lot of these towns?
[00:29:00]  Yeah, that there are, I mean, community banks, first of all, the community banks took a huge hit after the 08 crisis and they were really unfairly, you know, a lot of them had to close, I think unfairly, and others have said as well.
[00:29:16]  And also a ton of mergers happened in the wake of the 08 crisis where people were just eating up other banks.
[00:29:25]  And so you had an outcome of like, you know, so many less banks than there were prior to the crisis, which only, and of course, as we know from our good friend Mr. Carl, that as capitalism tends towards monopolization,
[00:29:39]  as firms not wanting to compete with each other, start absorbing each other, they're able to further like dominate and kind of set the terms for marketplaces.
[00:29:56]  So you have total capital flight from rural centers because there's no capital incentive to be there.
[00:30:03]  There's no jobs.
[00:30:04]  There's no infrastructure.
[00:30:06]  And then so it's like a snowball effect.
[00:30:10]  There's no way once that starts happening.
[00:30:13]  And once capital flees, I mean, it's like a parasite or a virus that then spreads throughout all different sectors of rural economies.
[00:30:24]  So it's in the case of hospitals and financing and local financing, but then it's seen in taxes and commercial real estate, which then sees it in jobs and unemployment.
[00:30:33]  And it becomes a kind of death spiral.
[00:30:37]  Sorry, that was not a little right.
[00:30:38]  No, it's fine.
[00:30:40]  You've described precisely how hospitals work in the U.S. right now.
[00:30:43]  Hospital monopolization is a very real thing.
[00:30:45]  It's being driven by private equity.
[00:30:47]  Hospitals that consolidate can afford to charge higher prices because no one can stop them.
[00:30:51]  And monopolized hospitals shut down rural clinics because they're not profitable.
[00:30:57]  It is expensive to treat sick populations.
[00:31:00]  You have worse outcomes when your population base is sick.
[00:31:02]  That's why SF General, sorry, Zuckerberg, can suck because they're dealing with a base of people.
[00:31:08]  Zuckerberg.
[00:31:09]  They're dealing with a base of patient population that is way sicker than other hospitals in the city.
[00:31:15]  If you go out in front of Zuckerberg, there'll be like 40 junkies just like sitting there, I guess, waiting for their appointment.
[00:31:20]  Oh, I mean, Oakland General is horrifying.
[00:31:23]  Yeah, it's terrible.
[00:31:24]  And like you go in, I mean, I waited four hours in the doctor's actual office for a dermatology appointment once.
[00:31:30]  It's like they just, they have staffing issues, but also just like the hospital administration doesn't need to make it better.
[00:31:37]  Well, there's also a secondary factor there, which is the idea of value-based payment, which is Warren's plan for maternal mortality.
[00:31:45]  And it's really, really bad.
[00:31:46]  Yes, I wanted to bring that up actually because it's structured similarly to what Obama tried to do with schools.
[00:31:53]  Wait, so let's go back.
[00:31:54]  What is it?
[00:31:54]  So value-based payment is the idea that you pay for performance.
[00:31:57]  You give hospitals that give a good job more money and hospitals that do a bad job less money.
[00:32:01]  And the problem there is that hospitals that do a bad job do a bad job because their patients are sicker.
[00:32:06]  Yes.
[00:32:06]  Yeah, but also they do a bad job sometimes probably because they don't have that much money.
[00:32:10]  Right.
[00:32:11]  Exactly.
[00:32:11]  Yeah, it's a spiral.
[00:32:12]  And so what it would actually lead to is more deaths of women, actually.
[00:32:18]  So this is just as dumb as it sounds?
[00:32:20]  Yes.
[00:32:20]  It's literally financial and it's saying that we don't have enough financial incentives in place in healthcare.
[00:32:29]  That's Elizabeth Warren's plan for dealing with maternal mortality.
[00:32:32]  So we have VBP in Medicare.
[00:32:34]  Sorry, we have value-based planning, payment, and Medicare already.
[00:32:38]  It's used, and it's failed over and again.
[00:32:42]  It also, like, there's a racial component to that because 30% of doctors treat 100% of black patients.
[00:32:49]  70% of doctors treat no black patients at all.
[00:32:50]  Like healthcare is racialized.
[00:32:52]  And it happens to be in areas that have been made sick, have been exploited, have been made poor.
[00:32:57]  Look at the fucking shipyards out here in sort of the big, the last basically mostly black neighborhood in San Francisco, baby Hunter's Point.
[00:33:06]  There's this ex-Navy shipyards full of radiation.
[00:33:10]  And it's like you get breast cancer there.
[00:33:11]  Like it's like one of the highest rates in America or whatever.
[00:33:14]  People have like a 10, or it's way more than, I think it's like 20 year life expectancy less from natural causes than they do anywhere else in the city.
[00:33:22]  The infant mortality rate in Memphis, Tennessee, and the black neighborhoods that are pushed up against nuclear waste disposal sites is 20 per thousand.
[00:33:29]  Yeah.
[00:33:30]  Which is an in like that number doesn't exist anywhere else in the first or something.
[00:33:34]  These are incredibly poor areas.
[00:33:36]  Yeah.
[00:33:36]  Yeah.
[00:33:36]  With absolutely no, like, I mean, that's the other thing is that then you have like these hospitals and like we were saying, Capital is already fleeing these areas saying if you have better outcomes, which would require them to actually reinvest in communities, which would cost them more, they would get more money.
[00:33:55]  It's just completely backwards.
[00:33:57]  It doesn't work.
[00:33:58]  It's cheaper for them to have better outcomes by excising poor and sick people than it is for them to attempt to treat them.
[00:34:05]  Yeah.
[00:34:06]  One of the things I touch on in the book, and this is not my idea, this is the idea that anybody who's ever worked in healthcare already knows, is that in like the lifespan of a person being sick and going to the hospital and having an outcome or getting sick or dying or whatever, the point at which they begin seeking medical care happens like at best midway through the process.
[00:34:23]  Yeah, right.
[00:34:24]  Like you die way faster of exposure than of cancer, for example.
[00:34:28]  If you want to improve maternal outcomes, for example, if you want to decrease maternal mortality, you got to get involved before the person even becomes pregnant.
[00:34:38]  Like a person who was pregnant in a home that's full of mercury or lead or whatever.
[00:34:42]  Yeah.
[00:34:44]  Like you can't do a whole lot.
[00:34:46]  You can like do your best to try to bring up birth weight.
[00:34:48]  But like the lead and mercury were there when they got pregnant.
[00:34:51]  You intervened way too late.
[00:34:52]  So we kind of pushed this all on the hospital and the hospital is structurally incapable of handling it.
[00:34:58]  So it does a bad job because of course it's going to do bad.
[00:35:00]  It's been set up to fail and we punish it by slapping it out of the wrist and taking 100,000 bucks away from it or whatever.
[00:35:06]  So in poor areas where you're already going to get sick, because for instance, yeah, like there's lead in the walls or in the water.
[00:35:14]  And the hospital, of course, has way more sick patients that it really can't do anything about because it's not, obviously the hospital isn't going into people's houses and like tearing whatever the paint off and putting new paint up that doesn't have lead in it.
[00:35:26]  They would get less money because their patients would have worse outcomes because the community is poor.
[00:35:35]  Yeah, so it's a perverse incentive for hospitals then to just not treat the sick patients to basically get them off their balance sheet.
[00:35:42]  Yeah.
[00:35:43]  To an extent, yes.
[00:35:44]  And this is exactly what Obama, I mean, it's literally what Obama did with education, where it was giving quote-unquote low-performing, I mean, low-performing public schools financial incentives to improve outcomes.
[00:35:59]  And we know it's been an absolute failure.
[00:36:03]  So this idea, I mean, it's a thoroughly neoliberal, sorry to say the N-word, solution that really needs to be called out for what it is.
[00:36:19]  Let's keep doing it.
[00:36:22]  Yeah, it sounds, it's crazy.
[00:36:24]  It's like one of those things where I'm like, I'm always like, nah, I can't be as stupid as it seems because I'm dumb.
[00:36:29]  And if I think it's dumb, it's like, I'm sure it's bad, but it's probably not dumb.
[00:36:35]  But this seems like an idiot's plan.
[00:36:39]  One of my frustrations with health policy academia is that it keeps rediscovering its own navel.
[00:36:46]  Do you just say that about academia?
[00:36:48]  Yeah, yeah.
[00:36:50]  But like we know what things work and don't work and we constantly re-examine them because academics are required to examine things to keep together grants.
[00:36:56]  So we examine things like work requirements.
[00:37:00]  We know that work requirements don't work and yet someone's got to research them.
[00:37:03]  So academics do, and therefore, by researching them, give credence to the idea that these things ought to be examined.
[00:37:08]  And through that process, they ought to be tried.
[00:37:10]  It's dumb.
[00:37:11]  It's very, very silly.

=== Buying Hospitals at the Highest Rate (08:10) ===

[00:37:12]  A secondary factor in the rural hospitals is you've got massive bases of uninsured people.
[00:37:18]  Yeah.
[00:37:19]  And especially in places like Texas, where 18 rural hospitals have closed in the past decade.
[00:37:24]  Jesus.
[00:37:25]  That's a lot.
[00:37:26]  Yeah.
[00:37:26]  More than, sorry, past five years.
[00:37:28]  I think it's a lot less than that.
[00:37:30]  My home state of Texas, you have lack of Medicaid expansion.
[00:37:34]  So you have even more uninsured people.
[00:37:37]  So the rural hospital, and let's get it clear, I'm not trying to say rural hospital good, big hospital bad.
[00:37:42]  You've got a lot of rural hospitals that do a lot of fraud, which is often because they don't have money in the first place.
[00:37:48]  It's kind of like stealing bread to feed your family.
[00:37:50]  But you've got a lot of bad actors all over the board.
[00:37:53]  So I'm not trying to build this very simple kind of morality play of small, good, big, bad.
[00:38:00]  And some big hospitals do really amazing initiatives to help people in their communities.
[00:38:05]  But in general, this is the structure that I've seen.
[00:38:08]  So rural hospitals have a lot of uninsured patients.
[00:38:12]  Thing about treating uninsured patients is you don't get paid because then they don't have insurance.
[00:38:16]  So you got to give them bills of $100,000.
[00:38:18]  They go bankrupt.
[00:38:19]  You don't get any money.
[00:38:20]  Nobody's happy.
[00:38:22]  And that leads to hospital closures accelerating.
[00:38:25]  I think hospitals in non-expansion states close six times faster than hospitals in expansion states.
[00:38:32]  So you've got a bunch of different, like that kind of payer mix.
[00:38:35]  Because no one has private insurance in rural areas.
[00:38:37]  If you do, you're lucky.
[00:38:38]  No one's got employer insurance.
[00:38:40]  It's mostly Medicaid and Medicare that are paying.
[00:38:42]  Yeah, because they don't have to like, yeah.
[00:38:44]  Because there's no jobs.
[00:38:45]  There's no jobs.
[00:38:45]  Right.
[00:38:47]  Or they keep you a part-time or you're an Uber driver.
[00:38:49]  Well, before we get into employment stuff, because I do want to talk about that.
[00:38:52]  I would love to.
[00:38:53]  Let's talk about private equity.
[00:38:55]  Yes.
[00:38:55]  Which is like the big That is like the pedophile industry Huge specter haunting the United States private equity They have their hands everywhere.
[00:39:10]  It's really really awful So I can summarize private equity's role in two anecdotes I think in in in the healthcare sector one they spent $60 billion last year buying up hospitals And usually hospital corporations or hospital monopolies will sell off their lost leaders, sell not lost leaders, sell off their least profitable hospitals.
[00:39:31]  Again, their poor urban hospitals and their rural hospitals to PE, who then turn them around, over-leverage them, and flatten them.
[00:39:38]  Right.
[00:39:39]  And they're spending a shit ton of money to do this, and no one is stopping them.
[00:39:43]  And this kind of like, this also leads to further consolidation because PE firms buy multiple hospitals and then merge them together into being the same group.
[00:39:51]  And hospital monopolies are, to some extent, immune to the charms of single-payer because it's hard to negotiate.
[00:39:58]  If you only have one hospital in a state or one hospital group in a state, you lose that leverage because you can't be like, these guys will give me this deal, you're yeah, yeah they.
[00:40:06]  They have the power to kind of set their own prices, whereas in normal single payer, because the payer is so huge, it can say, we're gonna pay a 20g for a leg replacement or whatever, take it or leave it, and hospitals kind of got to take it.
[00:40:18]  When you have hospital monopoly, hospitals have way higher negotiating power and they control the costs or the prices itself.
[00:40:25]  Um, it's kind of a gnarly cycle um, and of course, they're not using this size and leverage to take care of people.
[00:40:31]  They're using it to extract higher costs from the payer um, so that's one anecdote.
[00:40:34]  They're buying up all these hospitals and merging them and it's not good.
[00:40:37]  Sometimes these hospitals are Catholic, and Catholic hospitals aren't required to do certain things from other hospitals.
[00:40:42]  For example, if you are a person who is having a miscarriage, Catholic hospitals will make you wait outside the hospital before bringing you in because god forbid they abort a fetus um, so people will bleed out in the lobby or whatever.
[00:40:54]  They won't do trans health care, they won't do uh, abortion care, even reproductive care, and when a Catholic hospital's in Minnesota it's a big problem.
[00:41:01]  When Catholic hospitals own all the other clinics in the area, you've got nowhere to go for hours to get, like your basic reproductive needs taken care of.
[00:41:09]  Right, hospital monopoly, bad and PE, Hospital Peace.
[00:41:12]  So peak it's PE and it's the Catholics, both uh friends to pedophiles um, who have uh really driven a lot of the hospital problems in the past.
[00:41:20]  So is the PE play then?
[00:41:23]  Because there's not a lot of money to be made, like what you're saying about how them like taking these, like buying up these hospitals and then kind of like turning them around, basically flattening them.
[00:41:36]  I mean there's not a lot of money to be made there.
[00:41:38]  They buy up a lot of big hospitals too, but it's really in the mergers right where they're making the money like mergers, the big money yeah, to get that like pricing power exactly.
[00:41:47]  Once hospitals merge, they can charge a lot more and insurers payers, can't do anything About it.
[00:41:51]  So it's a union, but for hospitals.
[00:41:54]  It's a class union.
[00:41:55]  Yeah.
[00:41:55]  It's a union, but for capital.
[00:41:57]  All right, I'm seeing.
[00:41:58]  Yeah, yeah.
[00:41:59]  So again, when we're talking about having that leverage, again, the biggest population possible having any kind of leverage over these price setters in negotiations,
[00:42:12]  that's really impossible to do when you're going up against like a very like one large firm that's owned by or one large hospital that's owned by one huge private equity corporation that has that leverage ability against you.
[00:42:30]  Yeah, this is like literally like, this is an actual like conspiracy to just rip us off.
[00:42:35]  Well, it isn't a conspiracy.
[00:42:36]  This is what class antagonism is.
[00:42:38]  This is how it plays out.
[00:42:40]  I mean a conspiracy in the sense that like people are conspiring.
[00:42:43]  I've got an actual conspiracy for you.
[00:42:46]  I'm laying on.
[00:42:47]  So this isn't, I don't know if this is in the book, but it's a thing that I heard and saw, but I couldn't cite it as such because I heard it from somebody who was working in the field.
[00:42:55]  But I can say it here because no one's reading my footnotes.
[00:43:00]  A PE firm acquired both a hospital chain and an equipment manufacturer.
[00:43:06]  And equipment manufacturing is its own fucking like Hydra.
[00:43:10]  Yeah, also Elizabeth Warren's daughter on the board of a medical device company.
[00:43:14]  Very good.
[00:43:14]  They do a lot of interesting things.
[00:43:16]  Yeah, Elizabeth Warren worked with Republicans to repeal the tax on medical device companies that was in Obamacare.
[00:43:23]  That's why I broke up with her.
[00:43:25]  Just throwing out out there, guys.
[00:43:27]  So there is a clause in, I don't know who regulates DMEs.
[00:43:31]  I don't know if it's FDA or not.
[00:43:34]  About, it's called the 510 clause, which is normally if I invent a brand new gizmo that does, if it's a, I don't know, like a brain scanner or whatever, and it's a brand new device, nothing like it on the market, it has to go through years of review, which is good.
[00:43:49]  It should, before I can sell it to hospitals and that kind of thing.
[00:43:53]  But there's a clause called the 510 clause, 510K clause, which is I can bring forward a device and say it is materially the same as an existing device and get fast tracked to bring it to market.
[00:44:03]  And so 510 products have the highest rate of recalls, the highest rate of problems, and the highest rate of like, what's the term for it?
[00:44:09]  Malpractice incidence of other devices.
[00:44:13]  Oh, because you can just really scam it and be like, oh, yeah, this is like an MRI thing, but it like costs nothing, but also it gives you cancer.
[00:44:21]  Well, you don't have to declare costs.
[00:44:23]  You just say this device in and of itself is basically the same thing.
[00:44:28]  This bandage is basically the same, this kind of bandage, and then turn it around and charge $100 for it.
[00:44:33]  Okay, it gets fast-tracked.
[00:44:35]  You can make a camo and call it like an operator's bandage or whatever.
[00:44:37]  I'm just saying, yeah, yeah, yeah.
[00:44:39]  I got you.
[00:44:39]  So there was a 510K product that was a kind of data package for pacemakers.
[00:44:46]  And this DME company was owned by a private equity company.
[00:44:51]  And the power equity company also owned a hospital chain.
[00:44:55]  And the hospital chain did a lot of cardiac care because it had a massive diabetes population.
[00:44:59]  And diabetes is a thing that leads to cardiac failure.
[00:45:03]  So there was pressure, like literal explicit pressure.
[00:45:06]  People were told to prescribe this analytics package that did virtually nothing, but cost $80,000 per patient into the pacemakers because they were getting, like, the PE firm who owned both companies told the hospital, you guys got to use this analytics package now.

=== Why Health Care Is a Pet Peeve (04:37) ===

[00:45:22]  Even though it costs way more and doesn't do very much, like we are your boss.
[00:45:26]  We say you should go for this.
[00:45:27]  And so they did.
[00:45:28]  And that's one way that costs go up virtually overnight.
[00:45:31]  PE firms, because they diversify, right?
[00:45:33]  They're very smart at what they do.
[00:45:35]  And as far as I know, it's not illegal to do that.
[00:45:37]  If it is, then hope they go to jail or hell.
[00:45:40]  They won't.
[00:45:42]  I'm not Catholic, but I used to be, and I cling to it because I really need hell to exist.
[00:45:48]  I really need the promise that these people suffer.
[00:45:51]  Yeah, hell exists.
[00:45:53]  I don't, I'm Jewish, and I'm like, as you can see by the pays, et cetera, all the gear I'm wearing, I'm pretty deeply related.
[00:46:02]  And the fact that Liz is wearing a wig, even though we're not married.
[00:46:04]  Excuse me?
[00:46:05]  I just make women wear wigs around me.
[00:46:07]  That's an orthodox thing.
[00:46:09]  You wouldn't understand.
[00:46:11]  I also believe in hell.
[00:46:13]  There has to be one, right?
[00:46:14]  People have to get punished.
[00:46:16]  I need one desperately.
[00:46:17]  I really want one.
[00:46:19]  Who's going to be down there?
[00:46:21]  Oh, my God.
[00:46:22]  First of all, anyone who's ever insulted me.
[00:46:25]  Second of all, people who, like that one bald municop lady who used to, a lot of people, true heads know what I'm talking about.
[00:46:33]  We used to fucking, they call her the bulldog.
[00:46:35]  Oh, I know who she is.
[00:46:36]  Yeah, she was a fucking jerk.
[00:46:41]  I heard some lady on the bus talking about it the other day, and she hasn't been a municop for like 10 years.
[00:46:46]  Anyway, she would be in there.
[00:46:48]  And also, hmm.
[00:46:51]  Anyone who doesn't follow me back.
[00:46:53]  Yes.
[00:46:53]  No fear.
[00:46:55]  That's it.
[00:46:55]  Just those, just those two categories.
[00:46:57]  People who don't follow back.
[00:46:59]  I want two hells.
[00:47:00]  One is real hell and one's cool hell.
[00:47:02]  Yeah.
[00:47:03]  Those are just the, it's like Dante's, it's like the Inferno.
[00:47:06]  That's just like the sixth.
[00:47:08]  Cool hell is for skateboarders.
[00:47:11]  Goths.
[00:47:11]  Goths.
[00:47:12]  Yeah.
[00:47:13]  Goth adjacent people.
[00:47:14]  Health goths.
[00:47:15]  Metalheads.
[00:47:18]  Yeah.
[00:47:19]  I want to go to that.
[00:47:20]  I want to go to cool hell, but I want real hell to be saved for, you know, our friends in the PE firms.
[00:47:25]  Yeah.
[00:47:26]  Slowly, circling back to what you're saying about PE, because I did want to, we did want to frame this kind of conversation as a like, why don't we have health care and what are we, why don't we have universal health care and what are we going up against?
[00:47:42]  And I think that One thing I do really want to touch on because I keep seeing this argued on the internet, the place where I live, and I really hate it, where it's like, well, Obama couldn't get the public option passed.
[00:48:00]  And so who knows what any Democrat president is going to get passed.
[00:48:04]  Therefore, there's no difference between Elizabeth Warren and Bernie Sanders and their commitment to universal health care.
[00:48:11]  And I want to like stomp that out because one, it's not true.
[00:48:18]  It's complete revisionism.
[00:48:20]  And if you know me, the one thing I cannot stand is any kind of revisionism about the Obama years.
[00:48:26]  We are an anti-revisionist podcast.
[00:48:28]  Yes.
[00:48:29]  Yeah, in more ways than one.
[00:48:31]  And two, this idea that, okay, people have been fighting for Medicare for all for over a century.
[00:48:42]  Bryce, you said your union has been supporting it since the 30s.
[00:48:46]  Yeah, 1930s.
[00:48:46]  Well, when it started, it's been for a nationalized health program since the beginning.
[00:48:51]  Yeah, and I think a lot of a lot of kids new to the game, which, by the way, welcome.
[00:48:56]  Happy to have you here, think that if we just get the right person in and we just get just the right amount of Democrats in Congress and get our little majority, then we can like sign, seal, deliver a universal health care bill.
[00:49:13]  And I don't think people really understand like exactly what we're up against.
[00:49:18]  And this is something that I really, like one of my pet peeves, I have a lot.
[00:49:23]  She gets quite, they're just regular peeves.
[00:49:27]  Is that for all this kind of like waxing poetic that I see from a lot of new young left people, which again, welcome.
[00:49:36]  I have heard a lot of young people are waxing these days.
[00:49:40]  You know, I don't, I question how seriously people take capital.
[00:49:46]  Well, I think it's people think that the government or like the state rather is just like.
[00:49:51]  A neutral arbiter.
[00:49:52]  Yeah.
[00:49:53]  Or, like, it's Congress, and if we get enough good people in Congress, we'll get universal health care, which, like...
[00:49:58]  That's not how it works.

=== What We're Up Against (05:40) ===

[00:49:59]  Yeah.
[00:49:59]  Yeah.
[00:50:00]  I mean, it's, it's, it, like, didn't parliament in Britain get like pro-rogued when they did NHS?
[00:50:07]  Or no, it's the steel companies.
[00:50:08]  You had to abolish parliament in order to nationalize.
[00:50:12]  And that was at a point.
[00:50:13]  Yeah, yeah, yeah.
[00:50:13]  And that was at a point.
[00:50:14]  I mean, there's a lot of people that think that the only reason that they were able to get the NHS in the UK is because it was so the country was like destroyed.
[00:50:23]  Exactly.
[00:50:24]  And in America, it's like, it's, the state isn't just like, you know, Donald Trump and like some other like pedophiles.
[00:50:32]  It's like a lot of pedophiles who work in business, do like Aetna and all these insurance companies and all these like hospital conglomerates.
[00:50:39]  Like they're part of the same thing that we're fighting.
[00:50:42]  So it's not just like you can't have like a good president and you need like a multi-pronged sort of approach.
[00:50:47]  You think James, I mean, for example, and I was telling this to Brace earlier, but it's such a great little anecdote.
[00:50:53]  And I don't have anything great to say about Barack Obama, but a bungler.
[00:51:00]  Yeah.
[00:51:01]  The old bungler himself.
[00:51:03]  But there was an article in the New York Times that basically there was like kind of a rumor going around that Obama wanted to was threatening to by executive order ban dark money, which would have been, I mean, that would have been like, if he had just done that one thing in his administration, it would have been a success.
[00:51:24]  But of course he didn't.
[00:51:26]  But so there's a quote in the New York Times by one of the lobbyists from the Chamber of Commerce or good friends at the Chamber of Commerce, which by the way have an office directly across the street from the White House, just so that, you know, anytime you're at the White House looking out on the veranda, you can look straight at who's actually in power in this country.
[00:51:48]  It's the Chamber of Commerce.
[00:51:50]  And he said, quote, we will fight it through all available means.
[00:51:55]  And this is in a direct reference to a lot of the conversations that were happening at the time about what to do with one Mr. Gaddafi in Libya, friend of the pod.
[00:52:05]  I was just looking at Gaddafi.
[00:52:07]  I'm literally looking at Gaddafi right now.
[00:52:10]  I was just about to, I was going to quote some Gaddafi fact after this.
[00:52:13]  He says, we will fight it through all available means to quote what they say every day on Libya.
[00:52:19]  All options are on the table.
[00:52:21]  So this is a lobbyist from the Chamber of Commerce in the failing New York Times literally threatening to kill Obama if he signs an executive order banning dark money, which is how everything is done, not just in the United States, but around the world.
[00:52:38]  So they will kill Bernie Sanders day one in office.
[00:52:41]  Well, you know, I'm not going to say that, but I will say that when we talk about these forces of private equity and these insurance companies and these hospitals, we are talking about much bigger, like capital in general is a much bigger, more serious force than just convincing caucuses in the fucking Congress, which is, by the way, largely a functionary body, but that's for another rant.
[00:53:11]  A lot of clowns.
[00:53:12]  Yeah, serious.
[00:53:14]  Real jokers, joker's trick.
[00:53:16]  Once again, Washington, D.C. gets to say the Joker's trick in the pod.
[00:53:20]  In Washington, D.C. Is that a joker voice?
[00:53:26]  That's my joker voice.
[00:53:29]  But I just, that's really, I like, I really want to stress this point because I don't think that people really, and you know, it's daunting, but I think that people really don't understand the forces that we're up against.
[00:53:41]  No.
[00:53:41]  And so, again, I was saying about the Russianism.
[00:53:44]  There's this whole idea that Obama came in with the intent to pass public option.
[00:53:49]  He got like shut down by Congress and he just like couldn't get it done.
[00:53:53]  And like, that's like factually, like, that's not what happened.
[00:53:57]  That is not true.
[00:53:58]  I don't know about his, what's in his heart and mind.
[00:54:01]  I don't even fucking care, to be honest.
[00:54:03]  It don't matter.
[00:54:03]  It don't matter.
[00:54:05]  Hearts and minds don't matter.
[00:54:06]  We're not idealists on this podcast.
[00:54:08]  Or the people in charge of invading Vietnam.
[00:54:12]  But him, Max Baucus, and everyone else involved with the, you know, the legislative slate and who was involved in all of the talks about the ACA, like, one, they shut out single-payer and public option advocates day one.
[00:54:28]  So this idea that it's just like, oh, well, we'll just lobby Congress once we get the right people in there.
[00:54:32]  No, that's not how it works.
[00:54:34]  They just shut him out.
[00:54:35]  They shut him out.
[00:54:36]  And then second of all, you know, a good thing to remember about Obama was that, and this isn't, you know, we were talking about this right before we started recording.
[00:54:46]  Sorry, I've been like really going off.
[00:54:49]  But, you know, this was one of the most important revelations from the Podesta emails was that Citibank had hand-picked his entire cabinet before a single vote had been cast in the 2008 election.
[00:55:05]  So you've already got an entire team that's, and this is at the height of the financial crisis with basically the status of every bank up in the air about who the government was going to bail out, why, when, how all this was going to go down.
[00:55:23]  Citibank basically determining who, signing off on who exactly they were okay with in every position.
[00:55:31]  So this idea that he was just hamstrung, he wanted to do this.
[00:55:37]  Like, no, that's not true.
[00:55:38]  That's not what happened.

=== Freedom vs. Control (14:19) ===

[00:55:40]  And so it's important to remember all of these things as we look towards 2020 and what is actually at stake with the fight for Medicare for all.
[00:55:50]  I would take that a little bit and say that these problems, like capital is not necessarily threatened explicitly by single payer.
[00:55:59]  Because it's just all we're doing is changing who's paying the bills.
[00:56:01]  We're not changing the bills that are being paid.
[00:56:04]  And so a lot of the, like, there's two problems in health policy.
[00:56:07]  That's oversimplification.
[00:56:08]  There's cost and there's coverage, right?
[00:56:11]  Cost is, the coverage is who is and is not being covered by insurance.
[00:56:14]  Cost is how much does it cost to insure them.
[00:56:17]  The coverage problem single payer solves, but it's not, and it now is new positioning to tilt against those cost factors.
[00:56:23]  But like, there's a lot of ways that big hospital companies, pharma, et cetera, will be generally fine if, although a little bit flattened through single payer.
[00:56:32]  Single payer is not a revolutionary idea in and of itself.
[00:56:36]  And so I think that's why I think framing the fight as something bigger than just a single payer is interesting and worthwhile.
[00:56:44]  If you set your eyes on too small of a prize, then you're just, I don't know.
[00:56:47]  Like I feel bad about that.
[00:56:52]  Ultimately, we want to build a weapon that can be used to tilt against the forces of capital that are actually dominating and miserating people.
[00:57:00]  And I think that's way more noble and endeaffer than settling for something smaller.
[00:57:07]  Well, and I think what's important to then stress is what actually something like Medicare for All would do is not just, like you say, settle out like, you know, who pays for what and having this larger pool, which will lead to lower costs, although that is absolutely what will happen.
[00:57:25]  But that it would unteth, and this is what threatens capital, is that it would untether workers from their employers.
[00:57:34]  And this is a really, really important point because in the United States, we have a very, I mean, in the global north, but I mean, throughout the globe, but the United States has an incredibly weak, the situation with labor is incredibly weak.
[00:57:52]  Yes.
[00:57:53]  And I would say class consciousness is at an all-time low.
[00:57:57]  Yeah.
[00:57:58]  And there are very few routes towards reviving that.
[00:58:05]  And one of the clearest is by getting workers just a little bit more space from their bosses.
[00:58:14]  So when Bernie came and spoke at the ILW endorsement interview or whatever, we had like an hour and a half or hour about long sort of back and forth and there was question and answer thing.
[00:58:26]  And the head of ILW Canada sort of speechified because we were talking about Medicare for all.
[00:58:31]  And it's been a big thing.
[00:58:32]  You see a lot of news articles being like, a lot of unions don't like Medicare for all, which is definitely not as true as they make it sound.
[00:58:40]  Like there's been a big push in many unions, including many unions I don't even like, for Medicare for all.
[00:58:47]  But it's the Canadian guy was like, we don't have to bargain for health care where we are.
[00:58:52]  And like we can just bargain for wages and that gives us more leverage.
[00:58:56]  And it also gives us more leverage to strike.
[00:58:59]  Because if you look at UAW, like you were saying, like some kid, some kid of a worker lost his cancer coverage, right?
[00:59:07]  Yeah, yeah.
[00:59:08]  And like, it's, it's, it makes it a lot harder to decide to strike when you're sick or when you somebody where you're worried about your kids if they get sick or something like that.
[00:59:17]  It gives you a lot more freedom to do that.
[00:59:19]  But also what I do like about Bernie's plan is that if like he says, like they would, they wouldn't just be able to, the company wouldn't just be able to keep those costs.
[00:59:28]  They would actually have to pay them to the worker in the form of wages.
[00:59:33]  That would be huge.
[00:59:34]  That'd be like a huge, that'd be like a 15% raise for some people, like 20% raise for other people.
[00:59:40]  It's insane.
[00:59:41]  And it would give them, I mean, first of all, it would just boost people's wages like fucking crazy.
[00:59:47]  But it would give people freedom to not like be stuck in shitty jobs or to be stuck in shitty marriages or something like that.
[00:59:57]  Because universal healthcare, you don't have to make all these decisions basically based around other people ability to withhold health care from people.
[01:00:05]  Right.
[01:00:05]  The first thing they do is take away your kids' healthcare.
[01:00:08]  Whether you want to strike, whether you want to say fuck you to your boss, whether you want to take a, I mean, fucking take a sick day one too many times at a shitty job.
[01:00:18]  The first thing they do is take away your kids' healthcare.
[01:00:20]  So you are shackled to your employer.
[01:00:22]  Your employer dominates every aspect of your personal health.
[01:00:25]  Like literal agency, but whether you have the dignity of being free in your own body is tied to whether or not your boss is a prick.
[01:00:32]  Which is insane.
[01:00:33]  Right.
[01:00:33]  It's servitude.
[01:00:35]  It's a form of servitude to your employer that literally shackles the determinations of life and death to how good your boss feels that day.
[01:00:43]  And this is a great unshackling, I think, like you guys were saying, of American labor.
[01:00:48]  It's a reprieve.
[01:00:49]  The boot is being taken off the neck, at least a little bit.
[01:00:51]  And my hope is that that gives us, like, so there's this documentary called Fix It, which makes single payer rounds.
[01:00:57]  I've run into it a couple times, like two touring comedians or two touring stage musicians.
[01:01:02]  And I fucking hate it.
[01:01:03]  This documentary sucks ass because it's a documentary aimed at small business owners saying you'll pay less in healthcare costs.
[01:01:10]  And I posit, I believe, that small business owners, maybe some of them are good.
[01:01:15]  Like not all business owners are bad.
[01:01:16]  Like some of them are nice people, apparently, allegedly.
[01:01:21]  But this does like relinquish their control over their employees in ways that they might not care for.
[01:01:26]  And so I think this idea of like the rainbow connection, the friendship circus of trying to bring aboard business owners under the auspices of this will help reduce your per-person employment costs, I think is ill-conceived.
[01:01:41]  Yeah.
[01:01:41]  And frankly, I don't care for it.
[01:01:43]  Yeah.
[01:01:43]  I mean, I think that what's been lost in a lot of these like healthcare debates is this like exact thing that we're talking about, which is that even just this, the small lift of the boot on someone's neck, like just getting it a little bit further off your neck, what with a universal healthcare system, like we're saying, what that would do to just, I'm not saying that that would overnight lead to more labor,
[01:02:12]  like a larger labor movement, but it would fucking help so much.
[01:02:20]  Yeah.
[01:02:21]  It is nearly impossible like to participate in any kind of labor activity when your life or your kids or your wife or your husband, or whatever their health, their life and death, is tethered to your paycheck.
[01:02:42]  I think, in sort of the best case scenario of trying to get single payer Medicare for all is both like a, like I was saying, like a multi sort of pronged assault from both hopefully a Bernie Sanders presidency, but also really from labor, which is like what can, I think, sort of tip the scales in its favor.
[01:03:03]  Because you could do things like strike, or you could do things like have these big, you know, labor actions of whatever kind, pushing for it instead of just like relying on basically like whatever Joe Kennedy, who's going to probably be elected next year, right?
[01:03:20]  And all those fucking pervert freaks from voting for it.
[01:03:24]  Like you can really pressure them in other ways to do it.
[01:03:26]  Well, yeah, I think that's what's really been lost.
[01:03:29]  I mean, this is part of the kind of like, you can call it neoliberal, you can call it late capitalist, you could call it capitalist realism, like Mark Fisher says.
[01:03:38]  But this sort of, like, kind of cancellation of the future, he calls it.
[01:03:43]  But just the idea that...
[01:03:44]  Cancel culture.
[01:03:45]  Yeah, I was about to say, damn, cancel culture was real.
[01:03:48]  He got cancel culture.
[01:03:49]  I guess he did kill himself because of cancel culture.
[01:03:52]  Yeah, seriously, cancel culture is real.
[01:03:53]  Mark Fisher's not around to tell us about it.
[01:03:55]  Just keep that in mind, my friends.
[01:03:57]  But that, you know, that there are no actions, like that basically, like, it's kind of like what Margaret Thatcher says, there is no alternative, like that there are no actions outside of what we know how quote unquote politics gets done, which is that it goes to the legislative branch.
[01:04:16]  It goes to like, whatever, whatever.
[01:04:18]  And so our understanding of what's possible is inherently limited to that scope.
[01:04:25]  And by the way, the politicians would like to keep it that way.
[01:04:29]  They don't want, you know, a mass labor movement would not happen through simply like pressuring congresspeople to pass law.
[01:04:40]  You know what I mean?
[01:04:41]  Exactly.
[01:04:41]  Yeah.
[01:04:42]  But so a lot more is at stake here on capital's end than just some free health care.
[01:04:51]  Yeah, than just like a better price setting mechanism.
[01:04:54]  Yeah, exactly.
[01:04:55]  And I think that that really has been lost in a lot of these conversations, especially when, you know, my little hobby horse and Mr. Brace has been taking, you've been all Twitter fingered about this recently.
[01:05:08]  Oh, about Elizabeth Warren?
[01:05:10]  Yes.
[01:05:11]  Yeah.
[01:05:13]  The driest woman in the world.
[01:05:16]  Yeah.
[01:05:17]  Still wants to do it, though, which sucks.
[01:05:19]  Get all fucked up.
[01:05:20]  That's why we need free health care.
[01:05:21]  My shit's all fucked up from it.
[01:05:24]  I mean, yeah.
[01:05:25]  My dick's all fucked up from Elizabeth Warren's drive vagina, which is why we need free health care.
[01:05:32]  That's why you go to the dick doctor.
[01:05:34]  Yeah, it's I go to the dick doctor who charges me an arm and a leg.
[01:05:38]  Because she's been incentivizing your dick hospital.
[01:05:41]  Yes.
[01:05:42]  Does a poor performance at the hospital.
[01:05:45]  I think, too, and this is maybe going to lead us in a different, or I don't know, it kind of all goes together.
[01:05:53]  And this is something I think that you kind of touch on in your book very eloquently, is about how we conceive of healthcare as consumers.
[01:06:05]  And this is something that kind of Elizabeth Warren, I've noticed, is the way that she talks about, it's kind of her worldview, actually, which is a major ideological difference between her and Bernie Sanders.
[01:06:15]  But that like there's this idea of having like consumer freedom and choice in the marketplace and having the freedom to go out and buy insurance or have and choose between plants.
[01:06:31]  Choose between like you were saying, bronze, silver, HBO, whatever.
[01:06:34]  It's just like the choosing between plants, but it's like we conceive of healthcare as something that even belongs in a marketplace, even a well-regulated marketplace.
[01:06:46]  Right, and it's fundamentally a non-market good for a bunch of different reasons.
[01:06:50]  And the idea that you can force it into one is this genuflection to the idea that markets are the only thing that can exist, like what you were saying.
[01:06:59]  And it's stupid.
[01:06:59]  It's short-sighted.
[01:07:00]  And it doesn't, it takes, it's the kind of idea you would have if you've never experienced healthcare before, if you've never needed to go to the doctor, if you've never been sick.
[01:07:08]  The idea that what we need is more freedom in the quote-unquote consumer freedom and the provision of healthcare ignores that, one, that freedom has a massive time cost.
[01:07:17]  You become bogged down in the things you got to do to access that healthcare.
[01:07:21]  And two, that you are entirely unable to predict how much healthcare you will need in a given year.
[01:07:27]  These things are always surprises upon you.
[01:07:30]  And you don't have a relationship with health that has a flexible demand base or whatever.
[01:07:35]  When you need it, you need it.
[01:07:36]  And when you are forced to pay for costs you can't afford, you just don't seek healthcare and therefore get sicker down the road.
[01:07:42]  These things don't fit market models.
[01:07:45]  And they never will and they never can.
[01:07:47]  And so the demand that they do is to ignore the realities of what this thing is because you believe that markets are themselves somehow the paramount expression of being.
[01:07:56]  Yeah, and this ties into just kind of like larger liberal conceptions about what we would call like freedoms, which are that the two liberal freedoms that are that like everything is kind of centered around both individual freedom and property.
[01:08:15]  Yes.
[01:08:16]  And so the idea that rights, individual rights, are kind of negotiated within, this might get me in trouble.
[01:08:24]  I don't know if I should get into this.
[01:08:26]  Go for it, baby.
[01:08:26]  It's going to get me going off about abortion rights.
[01:08:28]  I came to her.
[01:08:29]  I gave her the idea.
[01:08:31]  So whatever she's about to say.
[01:08:34]  Oh, I know what you're about to say.
[01:08:35]  That says this isn't going to get you in trouble.
[01:08:37]  That basically like.
[01:08:39]  Are you talking about how?
[01:08:40]  Talking about how I hate Roe v. Wade.
[01:08:42]  Oh, I didn't know about that.
[01:08:43]  Oh, yeah, because it's like it, whatever.
[01:08:45]  Roe v. Wade will never do what people think it will do.
[01:08:48]  And it cannot because of the way that it's conceived.
[01:08:51]  Go off, Queen.
[01:08:53]  In the same way that we think of healthcare.
[01:08:55]  This ties together.
[01:08:57]  But Roe is not.
[01:08:59]  People think that Roe is a right to an abortion.
[01:09:03]  It is explicitly not.
[01:09:05]  It gives you, I mean, to get really vulgar, but this is totally true.
[01:09:09]  It gives you the right to go purchase an abortion in the marketplace, which means that what it says is not that the state, it's a negative right, not a positive right, meaning that the state does not have, through privacy, right, through the creation, because it doesn't really exist, in the 14th Amendment of the right to privacy, that the state therefore has no material interest getting in your way as you go to purchase an abortion in the marketplace, which is a private right.
[01:09:39]  So the state does not have an interest in facilitating the expression of that right through either paying for it or through ensuring that it is, you can actually, you know, express that right.
[01:09:56]  So this can't get in your way if you want to do it in a private transaction.

=== What Constitutes an Undue Burden? (04:08) ===

[01:09:59]  Exactly.
[01:10:00]  And so it is absolutely not a substantive right.
[01:10:03]  So, but if all private, whatever, purveyors of abortion decide not to do it or like are basically pushed out of being able to do it, whatever.
[01:10:14]  Well, no, because there's laws in place.
[01:10:16]  Yeah.
[01:10:16]  But I mean, do those laws mean much?
[01:10:18]  I mean, look at the problems.
[01:10:19]  No, they do.
[01:10:19]  But the problem is, is that since, well, there's a couple things.
[01:10:23]  Since Planned Parenthood v. Casey, that what has shifted in terms of where the kind of legal battles get kind of like hashed out is over what constitutes an undue burden.
[01:10:38]  Gotcha.
[01:10:38]  But that just reinforces, re-inscribes the fact that this isn't a right.
[01:10:44]  Because now what is being debated about, and this has been going on since whenever Casey was 92, 95?
[01:10:53]  What do I look like?
[01:10:54]  Casey?
[01:10:56]  But so all legislative action and legal action, which by the way is all determined by bourgeois big law, which have absolutely no interest in creating substantive rights.
[01:11:10]  No.
[01:11:11]  Because again, they're all liberals.
[01:11:14]  But is that it's all over whether or not in any given situation, the state is either getting in the way too much or not getting in the way too much, right?
[01:11:25]  What constitutes an undue burden on a woman expressing this right.
[01:11:30]  And also, there's a lot of quote-unquote nonprofit, the nonprofit complex talk about Planned Parenthood.
[01:11:38]  There's others.
[01:11:39]  I'm not going to get into it.
[01:11:40]  I don't need to name names.
[01:11:42]  I would say I worked for Planned Parenthood briefly in 2014.
[01:11:47]  Yeah.
[01:11:48]  And I mean, yeah, like they, they are so effective not at doing what they do.
[01:11:54]  Sorry, not at doing what they say or claim to do, but at squeezing out possible donation dollars.
[01:11:58]  Well, exactly.
[01:11:59]  Hilarious.
[01:11:59]  And here's the question is if these organizations are committed to reproductive health, why the fuck, and I will use that, I don't like swearing, but I will use it now because I'm very angry.
[01:12:12]  Why the fuck are they not supporting Bernie Sanders and Medicare for All?
[01:12:16]  Well, because it would put them out of business.
[01:12:18]  Yes.
[01:12:19]  Perhaps they wouldn't be able to get the donations that they would if we took reproductive rights out of the sphere of cultural and legal battles and into the sphere of health care.
[01:12:33]  And here's the thing about Medicare for All is that it's basically a workaround to the toxic Hyde Amendment, right?
[01:12:39]  I mean, Bernie's bill has this written in.
[01:12:42]  And I'm not saying there wouldn't be legal fights, but it would change the terrain of where those laws are fought.
[01:12:49]  So it would be fought on the terms of healthcare rather than this liberal conception of rights, of marketplace.
[01:12:57]  It would turn it into a battle for a positive right.
[01:13:01]  Damn.
[01:13:02]  And so this is, and so people really need to ask, like, you know, remember in 2016, Bernie got all that shit for calling Planned Parenthood the establishment?
[01:13:11]  He wasn't wrong.
[01:13:12]  It's big abortion.
[01:13:14]  Yeah.
[01:13:14]  And so we've got to, you know.
[01:13:16]  We need more mom and pop abortionists.
[01:13:19]  I mean, honestly, we do.
[01:13:20]  We do.
[01:13:21]  We literally do.
[01:13:22]  Well, what we need is, I mean, when you see organizations that are putatively feminist, or, you know, I'm a big fan of saying if people call themselves feminists, then I'm going to take them at their word.
[01:13:35]  If this is feminism, then that's feminism and we should critique it on those terms.
[01:13:39]  Yeah.
[01:13:40]  If Alexandria Ocasio is a socialist, I'm going to fucking critique socialism on her terms.
[01:13:46]  But that's for another podcast.
[01:13:49]  But if all of these, you know, ostensibly feminist nonprofits, big feminist law, all of this shit is not supporting the thing that will guarantee reproductive rights for all, will guarantee healthcare.
[01:14:06]  Well, it's self-preservation.

=== People in Clinics: Four to Seven Days (03:32) ===

[01:14:08]  We've got to ask why, and you just got to, you got to look at the money, right?
[01:14:13]  It's certainly a choice of self-preservation over the broader nominal goal.
[01:14:19]  I don't know enough to decide whether or not I think it is the money or not.
[01:14:23]  I know a little, but I don't know enough to actually decide that or to think about that.
[01:14:28]  Yeah.
[01:14:29]  But I wouldn't be surprised if that were the case.
[01:14:31]  Well, I would really, I mean, I think they've got a lot to answer for.
[01:14:34]  Their failure to get behind a single payer, like state-based single-payer is a bad idea for a lot of people.
[01:14:39]  It can never work.
[01:14:40]  But the fact that Planned Parent had gutted the Colorado movement is really telling.
[01:14:46]  And I really don't want to say they're afraid of being run out of business because it's a step too far for me.
[01:14:55]  I don't even think it has to be that explicit.
[01:14:58]  But I think, you know, when you see donations going down, I mean, that, you know, and by the way, they pay people a lot of money.
[01:15:06]  They've got high salaries on there.
[01:15:08]  Not necessarily the people in the clinics, of course.
[01:15:11]  But this is just the case of nonprofits in general.
[01:15:14]  Or the lawyers.
[01:15:15]  The lawyers are going to pay a lot.
[01:15:16]  Sure, I'm sure.
[01:15:17]  But you know who I'm talking about.
[01:15:20]  I work at a nonprofit and I'm a drug counselor part-time, right?
[01:15:24]  I love telling people not to do drugs and then also selling them oxycombs.
[01:15:29]  No brains.
[01:15:30]  Just playing on the second part.
[01:15:33]  But I go into one of the bigger, also nonprofit detoxes.
[01:15:41]  And it's like for street-level, like people, you know, just getting off of drugs and stuff.
[01:15:46]  A lot of homeless people, a lot of people who live in single-room occupancy, like hotels, stuff like that.
[01:15:51]  And recently, they changed the length of time that you can stay in the bed there.
[01:15:57]  It used to be 30 days and then they would get you into a program.
[01:16:00]  Like an actual program we live for like several months or a year or whatever.
[01:16:04]  Now it is seven days.
[01:16:07]  And the reason they're doing that is even though it's not only a health nonprofit and it doesn't, it makes enough money.
[01:16:14]  It's not like it's in the red or anything like that.
[01:16:17]  Because they get paid by the city and they get these fund this funds because like the amount of people they have there in a year, right?
[01:16:27]  So, I mean, if you, they can have four times the amount of people now, now that they, whatever, went from 30 days to seven days.
[01:16:34]  And it's been insane to see because the recidivism rates for like people who are in programs, it goes way up the shorter amount of time they're there.
[01:16:44]  Like the longer someone's in a program, every day like adds more chance that they will not go and use right when they get out.
[01:16:51]  And now it's like we have the same people in there every single week.
[01:16:54]  Like they get in, they're in there for four days or in there for a week because it's a seven-day maximum program.
[01:16:58]  They're in there for four days to a week.
[01:17:00]  And I won't see them maybe the next week and then they'll be back the next week.
[01:17:04]  This is one of the reasons that I'm really interested in health finance and health billing and how these things work.
[01:17:10]  Because you've got three basic models of paying for healthcare.
[01:17:14]  One is fee for service.
[01:17:15]  Doctor gives you an inventory and you pay for those things at their rates.
[01:17:18]  Two is a paper diagnosis or pay-per-like bundle of care.
[01:17:21]  A knee surgery in general is going to cost $20,000, even though it has many different components.
[01:17:26]  And thirdly, it's pay per capita, pay-per-person.
[01:17:28]  And all three of them have like massive downsides.
[01:17:30]  So finding the right balance of the Tetris game of like when do you use which for whom and how has like incredible life or death consequences for people all across the board.

=== Fee For Service Frustrations (11:33) ===

[01:17:40]  And like that's a really interesting problem because it's crucial to people's well-being.
[01:17:46]  And this determination has haven't spread across hundreds of actors that are fundamentally incompetent at realizing long-term benefit.
[01:17:55]  And as a result, we have models that are adopted by the public sector that do things like tamp down rehab rates to seven days instead of 30.
[01:18:02]  Like this, these questions are paramount in determination of life and death.
[01:18:06]  And we ought to bring our best hammer to the nail.
[01:18:10]  We need to have single payers.
[01:18:12]  We can assess these things in their full term.
[01:18:14]  There's actually, so there's, I don't mean to change topics.
[01:18:16]  No, go ahead.
[01:18:17]  So I think single payer, Medicare for all, Medicare for All that is single payer, not Medicare extra for all or whatever.
[01:18:24]  Medicare for all of us.
[01:18:25]  John, don't believe the podcast, Johns.
[01:18:27]  Fucking pressure.
[01:18:28]  We're coming after that.
[01:18:30]  Those are the Johns, some Johns Hopkins.
[01:18:32]  Also, remember, they're the ones who convinced Warren to take the DNA.
[01:18:35]  That's so fucking funny to me.
[01:18:37]  I want to be, and I know this has nothing to do with what they're talking about.
[01:18:40]  We can go back to this in one second.
[01:18:42]  Imagine, if you will, if Bernie Sanders had been like, oh, I'm Native American for like 20 fucking years.
[01:18:51]  What would have happened?
[01:18:52]  It's so fucking ridiculous.
[01:18:54]  She did red face.
[01:18:55]  It's not only that, she didn't until a lot of affirmative law action laws passed.
[01:19:02]  Yeah.
[01:19:02]  And she went from being a small town college professor to being tenured at Harvard Law and paraded around.
[01:19:10]  As their sole Native American.
[01:19:12]  No, the first woman of color professor of law at Harvard, which is, by the way, cited in a paper called Intersectionality and Positionality in the Academy.
[01:19:23]  America Rock.
[01:19:24]  I mean, it fucking writes itself.
[01:19:26]  And you bring this up to any one of these PMC Warren fucking liberal freak ass unfuckable dorks.
[01:19:32]  So it brings this up to your manager's manager.
[01:19:34]  You bring it up to them and they're like, this is like not really a problem.
[01:19:38]  I'm like, okay, bitch.
[01:19:40]  Yeah.
[01:19:40]  Anyways, back.
[01:19:41]  Sorry.
[01:19:42]  I think it's very funny.
[01:19:43]  I've just heard about that one.
[01:19:44]  You guys got it.
[01:19:44]  It's so funny.
[01:19:46]  I love that though.
[01:19:46]  See, these are all the anarchist white crusaders of the PMC that are like, actually, someone pretending to be another race isn't a problem.
[01:19:55]  Yeah.
[01:19:55]  It's like, all right.
[01:19:56]  Once again, the Dolezal is Elizabeth Warren for actual working people.
[01:20:00]  Because you can get her.
[01:20:02]  You can get her to say whatever you want on camera.
[01:20:04]  Have you ever read that Adolph Reed paper on Rachel Dahlazal?
[01:20:06]  No.
[01:20:07]  It's very good.
[01:20:08]  Oh my God.
[01:20:08]  Not a big read guy.
[01:20:10]  It's very good.
[01:20:11]  Okay.
[01:20:11]  I'll check it out.
[01:20:12]  You should.
[01:20:13]  I'm not a big reading guy.
[01:20:14]  Yeah.
[01:20:15]  Yes, you are.
[01:20:16]  You should see this notes this guy got.
[01:20:19]  Wait, so go off.
[01:20:19]  Okay, go off.
[01:20:20]  Sorry.
[01:20:21]  Excuse me.
[01:20:22]  I think single payer does two things beyond itself that are really interesting to me.
[01:20:27]  One is the emancipation of the person from domination by the employer for the health care of you and your kids, which lets us organize in new ways, strike, do things that really let us build a labor movement and a mass popular movement that we don't have in the U.S. right now.
[01:20:43]  But two is it forces us to think about health as a long-term spectrum of needs.
[01:20:47]  So right now, a big problem is that if you have private insurance, you have that private insurance plan for tops five years, six years.
[01:20:56]  Eventually, you churn off and maybe one day, God permitting, you go on Medicare.
[01:21:00]  So no private insurer, no, no, Signa, no Oscar, no whomever, really feels the pressure to take care of you long term, to give you what you need to stay healthy now or stay healthy in the future, because it's not their problem.
[01:21:12]  These questions of long-term health, of population health, are difficult and they're tedious and they're hard and they're not money makers, so nobody invests in them, right?
[01:21:25]  But once you have a single payer, a single payer, it bears the costs of providing care and it also bears the costs and the risks of what happens when care is not provided.
[01:21:35]  I think I say this in the book.
[01:21:37]  If, for example, a person is getting sick because they don't have access to housing or their housing is unsafe, it's full of mold, it's full of water, it's flammable or whatever, then they're going to the hospital, they're going to the doctor because of those conditions, then housing is healthcare.
[01:21:52]  And you got to invest in long-term, safe, social housing to bring healthcare costs down.
[01:21:57]  Same with food.
[01:21:58]  If you don't have access to food, so you're getting diabetes or comorbidities like cardiac failure, because it's not profitable to sell healthy food to poor people, and it's not profitable, but let them have the time to make food on their own, then you got to invest in making food affordable or even free and giving folks communal spaces to prepare it, communal social spaces to prepare food to bring long-term healthcare costs down.
[01:22:18]  And these things work.
[01:22:18]  Medicaid both sucks ass and also kicks ass because it's forced to invest in these things.
[01:22:23]  Because the Medicaid population is pretty sticky.
[01:22:25]  You tend to stay in Medicaid for a long time and it has to address these long-term health needs.
[01:22:28]  Otherwise, Medicaid goes bankrupt because it's a state-funded program.
[01:22:32]  So Medicaid does invest in housing and invest in food.
[01:22:35]  And when it does, it works really, really, really, really well when it can.
[01:22:39]  And we've got to, like, a single payer is incentivized and compelled to invest in these kinds of long-term investments that nobody else is doing right now or can do.
[01:22:48]  And that, I think, really broadens our idea of health care into what I am using the term health justice, which I think is also kind of emancipatory because it ties together the fights for environmental justice, reproductive justice, housing justice, immigrant justice, prison justice, into a tapestry of broader needs of whether you're permitted to be safe in your own body.
[01:23:08]  When other countries, like other countries, do have this concept, they don't express it very, very well.
[01:23:12]  But I've got one anecdote that I like a lot of what happened in Canada.
[01:23:15]  This happened like a month ago, and I like it a lot.
[01:23:19]  Quebec.
[01:23:20]  This takes place in Quebec.
[01:23:21]  Quebec is a province in Canada that I know for two things.
[01:23:24]  One, it's punishing and deeply problematic black metal music.
[01:23:28]  And two, it's low vaccination rates.
[01:23:31]  Quebec has a measles vaccination rate of, I think, 75%.
[01:23:36]  And for context, you want a 95% vaccination rate for immunity.
[01:23:41]  And so Quebec was saying, how the fuck do we handle this problem?
[01:23:44]  There are two kinds of folks that don't vaccinate their kids.
[01:23:47]  On one end, you've got the hardline anti-vaxxers, people that like no come hell or high water.
[01:23:51]  They will not vaccinate their kids.
[01:23:52]  This is not a thing they're going to do, but they're a minority.
[01:23:55]  Most folks kind of fall in the middle.
[01:23:56]  They're vaccine skeptical.
[01:23:58]  They don't want to hurt their kids, which is a good impulse.
[01:24:01]  And so they Google vaccines good or bad or whatever and look at the results, listen to the radio, watch TV, and go, oh, okay, there's a lot going on here.
[01:24:09]  Maybe I'll wait a little while longer to make a choice.
[01:24:11]  And in waiting, they choose not to make a choice and in doing so have made a choice and not don't vaccinate their kids or whatever.
[01:24:19]  And these are the folks Quebec thought they could reach.
[01:24:21]  So they hired 53 social workers and sent them like two or three hospitals.
[01:24:26]  And the social workers were vaccine counselors.
[01:24:28]  They'd go to the neonatal unit.
[01:24:30]  Oh, sorry, before that.
[01:24:32]  The reason they had to do this, doctors weren't getting the job done.
[01:24:34]  Doctors have limited amounts of time.
[01:24:37]  Doctors conceive of themselves as being very rational and they don't like working with irrational patients.
[01:24:43]  Doctors are pricks.
[01:24:45]  Often they're kind of brusque.
[01:24:47]  They don't handle people's squishiness well.
[01:24:49]  So they weren't getting the work done.
[01:24:50]  So Quebec hired social workers.
[01:24:52]  Social workers would go into the neonatal units and talk to families and say, hello, my name is Jean-Claude or whatever.
[01:24:59]  I'm your vaccination counselor.
[01:25:01]  Are you thinking of vaccinating your kid?
[01:25:04]  What information do you need to make this choice?
[01:25:07]  Here's some charts.
[01:25:07]  Here's some graphs.
[01:25:08]  Let me hold your hand and talk to you about it.
[01:25:11]  And fundamentally, whatever choice you make is yours, and I respect that, but I'm here to help.
[01:25:16]  And vaccination rates in those roved hospitals went from 73% to 87% over the course of a couple of months.
[01:25:22]  That's totally not surprising.
[01:25:24]  Incredible, right?
[01:25:25]  All this tedious labor.
[01:25:26]  It's always compassionate labor.
[01:25:28]  It's always nurses.
[01:25:29]  It's always social workers.
[01:25:31]  It's always home health aides who are, for the record, home health aids are paid $11 an hour and build it $120 per visit.
[01:25:37]  Mass exportation.
[01:25:38]  Yeah.
[01:25:39]  Home health aides often have to often live with their clients six days a week.
[01:25:43]  Which is fucking as somebody who has a family member who has a lot of health issues and also dementia.
[01:25:52]  God damn.
[01:25:53]  Yeah.
[01:25:54]  I think, I mean, they need a massive fucking national union.
[01:25:57]  But like that is a massively exploited paper base.
[01:26:00]  But these are the folks that actually make a difference.
[01:26:02]  It is not multi-millionaire surgeons.
[01:26:04]  It is not data packages.
[01:26:06]  It is not apps.
[01:26:07]  These are not the things which drive long-term health.
[01:26:09]  It is only social workers and nurses and food and housing and shelter and safety.
[01:26:13]  And that's a huge, I mean, we have to wrap up because we have gone way extra long, but this is so fun.
[01:26:20]  We could go for like another hour.
[01:26:22]  But that is also a huge component, if not like the structure of Cuba's health program, which has incredible outcomes.
[01:26:34]  They're always, that all of the Cubans because they're always sending doctors to us in our disasters.
[01:26:39]  They sent so many doctors to New Orleans after Katrina.
[01:26:43]  I thought they were refused entry.
[01:26:45]  They might have been, yeah.
[01:26:46]  I think they tried to.
[01:26:47]  They just sent some to Haiti, I believe.
[01:26:49]  Yeah, they always send, I think America refuses them entry, but they've always like, that's who, I mean, Brazil just kicked out all those Cuban doctors who are working in the, in like rural areas, who now, of course, have no doctors there.
[01:27:02]  But my understanding is that, and I believe that there were some clinics in Baltimore a couple years ago that were experimenting with these approaches.
[01:27:11]  And this is similar to what you're talking about in that the Quebecois, as I like to say, were doing.
[01:27:17]  Quebecie.
[01:27:18]  No, it's Quebecois.
[01:27:19]  Isn't that so nice?
[01:27:20]  No, it's Canadian French, Quebec.
[01:27:22]  Anyway.
[01:27:23]  But in Cuba, I mean, basically, you don't go to the doctor.
[01:27:27]  The doctor comes to you.
[01:27:28]  And so when they're doing home health visits, they're able to see, you know, what is this person eating?
[01:27:35]  What are they, how are they living?
[01:27:38]  What are their homes like?
[01:27:39]  What is the home situation like?
[01:27:40]  Because like you've stressed, and this is so important, so there's one, patients lie, by the way.
[01:27:47]  But also, there's so much more that goes into health than just what you're able to garner from a patient in an office.
[01:27:58]  You know, there is like, you know, how are people living and eating?
[01:28:03]  All of this contributes.
[01:28:05]  And so they have, I mean, Cuba is known, I mean, world famous for the caliber of their doctors.
[01:28:13]  Now, they don't get paid $800,000 or whatever, but not that doctors here make that money.
[01:28:19]  You know what I'm saying?
[01:28:20]  Some do.
[01:28:20]  I mean, like, I think surgeons, heart surgeons.
[01:28:23]  Let me question real quick.
[01:28:24]  I think a parallel fight is making medical training free.
[01:28:27]  Yeah.
[01:28:27]  Right now, one-third of doctors, people in med school come from the top income quintile, which is how you build.
[01:28:34]  If you have a doctor base that is that massively disproportionate, you get horrible health outcomes.
[01:28:38]  Well, the AMA has a little, I mean, they like to keep things pretty.
[01:28:43]  It's also a problem that we caused.
[01:28:44]  There was a fear in the early 90s, early 90s that we would have too many doctors by 2020.
[01:28:48]  So there was like a New Yorker cartoon of doctors in their breadline.
[01:28:51]  This is a Clinton era policy that we're still suffering from.
[01:28:55]  I have one more point just on this.
[01:28:57]  We know that these things work.
[01:28:59]  We know that long-term compassionate labor works.
[01:29:01]  We know that housing stuff works.
[01:29:03]  We know that legal services really work to bring up medical outcomes because you have all these legal rights against things that make you sick.
[01:29:10]  You only have access to them if you can afford to hire a lawyer.

=== Long-Term Health Models (07:37) ===

[01:29:13]  And like even the private sector is getting hip to it, right?
[01:29:16]  Like there's a big hospital in Orlando and there's University of Illinois in Chicago, which have begun building or buying up housing for their most frequent flyers, right?
[01:29:25]  And like that's cool.
[01:29:26]  That's good.
[01:29:26]  That does a lot to house people.
[01:29:27]  That's always a good thing.
[01:29:29]  Brings down their long-term costs.
[01:29:30]  But we simply cannot cede this kind of work to the private sector.
[01:29:34]  No.
[01:29:35]  Welcome to neo-feudal society.
[01:29:37]  Right.
[01:29:37]  I simply refuse the idea that we should let hospitals be the arbiters of who is housed and who is not.
[01:29:44]  This is why, and this is the thing, like this, this idea of like long-term health models, of really assessing finally for the first time population health as a people, for really thinking about why we get sick and tilting against it is, I think, the most exhilarating part of single payer, other than being able to afford my meds.
[01:30:01]  And like, along with the emancipation of the worker, this is like a thing that is so compelling and so rich and so juicy.
[01:30:09]  And I want it so desperately.
[01:30:12]  I think that's great.
[01:30:13]  Yeah, we were just actually talking about WeTwerk, WeWork, and how fucking horrifying they are.
[01:30:22]  And God forbid, I don't know if they're into like WeSick or whatever.
[01:30:26]  I can imagine they have some kind of like hospital expansion program that they're.
[01:30:30]  Microsoft, Amazon, Google, all of that.
[01:30:31]  I know Amazon is, they have a huge partnership with, speaking of fucking private equity, Berkshire Hathaway.
[01:30:37]  Yep, yep, yep.
[01:30:38]  And you know who their CEO is?
[01:30:41]  Atul Gawande.
[01:30:42]  He, oh, yeah, sorry, not of Berkshire Halfway.
[01:30:45]  Uh-oh.
[01:30:45]  No, of Amazon's unnamed health venture.
[01:30:48]  Yeah, Gawande.
[01:30:49]  He's a fucking like Obamacare defender, liberal activist doctor.
[01:30:54]  He is a New York Times best-selling author and New Yorker columnist.
[01:30:57]  And his writing isn't that good.
[01:30:59]  No, also, it's like, well, I wonder what kind of friendly, woke face Bezos wants to put on his health venture.
[01:31:06]  So Gawende had this piece that came out in 2000 and something.
[01:31:11]  He had this piece called The Cost Conundrum, which is and it was wrong.
[01:31:16]  We're discovering now that it was fundamentally wrong.
[01:31:18]  His model of how costs happen is not because of bad doctors, rogue doctors jacking up costs.
[01:31:23]  It was structural level problems and it was payment level problems.
[01:31:27]  And this myth that he put forward is the progenitor of value-based payment, of that you're trying to clamp down rogue doctors.
[01:31:34]  And this is a guy who's like on fucking Oprah.
[01:31:37]  I mean, he's like super famous.
[01:31:39]  You know what I mean?
[01:31:40]  He's beloved yeah, as this, like voice of liberal.
[01:31:45]  He's the Amazon scumbag, he.
[01:31:46]  And Stephan yeah, Atulgawende and Stephen Brill, who wrote America's Bitter Pill, which I think archived to you.
[01:31:52]  But I was not being clear, I was being semi-ironic.
[01:31:55]  Yeah yeah yeah uh uh no, I got that okay.
[01:31:57]  Are uh two of, like the archangels of the the, the worst neoliberal models of health in the?
[01:32:03]  U.s of how health works and how power works and how healthcare, how power works in healthcare, and how these things interact uh pragma, pragmatic healthcare, and it's stupid and I hate them.
[01:32:14]  I would say I oh, I didn't get a chance to go off on the public option, but I do.
[01:32:18]  We'll talk about it another time right, or we can talk about it today.
[01:32:23]  I just want to say that people think and the public option they do this really well.
[01:32:27]  People think that it's more like medicare for all, because it kind of sounds like it.
[01:32:31]  It's not.
[01:32:32]  It's got public in the name.
[01:32:33]  Imagine if you will, if someone took social Security and said okay, now we're gonna have it compete out in a marketplace with private retirement funds that are all well funded, meaning through advertising and marketing and trying to get you to it.
[01:32:51]  It's submitting public provisions to the marketplace.
[01:32:54]  It's definition by definition, neoliberal.
[01:32:57]  In that regard, it is not a move toward medicare for all.
[01:33:01]  It will be doomed to fail, which will stop almost all movements toward a national I mean single payer and then ideally, a national health service beyond that, um.
[01:33:13]  So don't be fooled either by the podcastrons or public option nonsense, because and you won't be because you listen to Journal and you're all brain geniuses public option is really stupid for a bunch of reasons, one of which is the fact that it sells out.
[01:33:29]  Any like single payer has some clear material advantages over um other uh healthcare models like single payer can do things that, like small insurers cannot do.
[01:33:39]  Public option concedes all that, all that space to to preserve and privilege private profit like that's only exists.
[01:33:45]  Two, if you want to talk about capital and healthcare um, there is no way that uh, the powers that be would permit a public option to actually threaten the, uh the the balance sheets of of private payers.
[01:33:56]  Look at student loans, for example.
[01:33:57]  Yeah, whenever student, whenever public student loan options um threaten to compromise the integrity of the private sector.
[01:34:03]  Sally Mace Thompson with 77 million dollars in lobbying and make sure that that the kibosh is put on that initiative.
[01:34:09]  Yeah yeah, no.
[01:34:10]  So it's all bullshit, except for Medicare, For All what it can do for emerging re-emerging, reforming labor movement in the United States, and obviously Bernie Sanders, who's the only option.
[01:34:25]  It's the only option.
[01:34:26]  Yeah if, if he doesn't get the nomination, to vote for Trump.
[01:34:32]  Brace, don't show your colour.
[01:34:33]  I'm imitating Bernie Sanders right there.
[01:34:35]  Brace, Strasserite, Brace.
[01:34:37]  No, no, no.
[01:34:38]  I'm not even voting for Bernie.
[01:34:39]  I'm voting for Kamala.
[01:34:42]  I'm going Tulsi.
[01:34:43]  Yeah.
[01:34:43]  Oh, dude.
[01:34:44]  Fuck.
[01:34:45]  Another woman I've had sex with.
[01:35:03]  This is so fun.
[01:35:05]  We could talk about this for hours.
[01:35:06]  I hope that our listeners are still listening and also that they don't get mad that we didn't talk about pedophiles too much.
[01:35:13]  So, Tim, what is your book?
[01:35:15]  Oh, my book, it's called Health Justice Now.
[01:35:21]  Single payer and what comes next.
[01:35:23]  It attempts to do three things.
[01:35:24]  One, explain what we have now.
[01:35:26]  What is insurance?
[01:35:27]  Why do we have insurance?
[01:35:28]  What is Medicare?
[01:35:29]  What is Medicaid?
[01:35:30]  Why do we have employer-sponsored insurance?
[01:35:33]  What are medical costs?
[01:35:34]  Where do they come from?
[01:35:34]  What is pharma, et cetera?
[01:35:36]  Number two, what we want.
[01:35:38]  We want federal single payer.
[01:35:40]  There's a spoiler alert from my book.
[01:35:41]  But what is that?
[01:35:42]  What does that mean?
[01:35:43]  How does this thing operate?
[01:35:44]  Why is it good?
[01:35:45]  What can it do?
[01:35:46]  What can't it do?
[01:35:47]  And then part three, what comes next?
[01:35:49]  Which is that broader idea of health justice.
[01:35:52]  Given that we have made the U.S. one of the most dangerous countries to be sick in, how do we really conceive of health as a long-term need?
[01:36:00]  How do we think about health and how we spend it?
[01:36:02]  How does health affect you differently if you're black or brown or trans or live in a rural area or are pregnant or whatever?
[01:36:08]  Like how do these things, like how does health manifest in these ways?
[01:36:11]  And how is single payer the only viable solution for making a more just healthcare state in the U.S.?
[01:36:17]  It also has a lot of wrestling references, making it the only healthcare policy book to mention Bret Hart and Chris Benoit, rest in peace.
[01:36:26]  He could have been saved by better mental health issues.
[01:36:29]  Didn't he fucking kill himself?
[01:36:31]  He had CTE.
[01:36:32]  He had the brain of an 80-year-old.
[01:36:34]  Oh, excuse me.
[01:36:34]  Better regular health.
[01:36:35]  His move, his finisher was a diving headbutt from the top rope.
[01:36:39]  Speaking of CTE, you know that MIT thinks that it's in healthcare?
[01:36:43]  MIT thinks that it's like just a couple years away from being able to diagnose CTE.
[01:36:48]  Dude, RIT sports.

=== Mental Health & CTE References (02:11) ===

[01:36:50]  You know who is.
[01:36:51]  Because they can only do it post-mortem now.
[01:36:54]  Right.
[01:36:55]  But like, that'll fucking kill the NFL.
[01:36:58]  Yeah.
[01:36:58]  MIT also has a center for CTE studies.
[01:37:02]  You know who funds it?
[01:37:04]  Who?
[01:37:04]  The Vince McMahon family.
[01:37:05]  Oh, no!
[01:37:08]  You guys, this fight is bigger.
[01:37:11]  It just keeps getting bigger.
[01:37:13]  Yeah.
[01:37:13]  Also, I had sex with Vince McMahon's daughter.
[01:37:17]  Tim, thank you so much.
[01:37:19]  This is so fun.
[01:37:20]  Thank you for having me.
[01:37:21]  I have fun with this.
[01:37:22]  This is fun.
[01:37:24]  We also have to thank you for writing the only non-pedophile policy book on single payer.
[01:37:32]  Exactly.
[01:37:32]  That's the Tim Faust guarantee.
[01:37:34]  Yeah, not a pedophile.
[01:37:35]  It actually, he has it notarized on the first page.
[01:37:39]  That's right.
[01:37:39]  I've got my thumbprint stamped right there.
[01:37:41]  Yeah.
[01:37:41]  Notary, seal my hand and wipe it.
[01:37:43]  I can go as close to a school as I want.
[01:37:45]  No one will stop me.
[01:37:47]  I can go in the school.
[01:37:48]  That's right.
[01:37:48]  Sometimes I carry the book through an elementary school above my head, waving it around, and no cop can stop me from doing that.
[01:37:54]  Absolutely.
[01:37:54]  That's the non-pedophile guarantee.
[01:37:56]  And yeah, and we here at Chunon can say the same.
[01:38:00]  I am Brace Belden, PhD.
[01:38:04]  That means fat hog and dick.
[01:38:10]  I'm Liz.
[01:38:11]  Thanks, guys.
[01:38:12]  We've got, of course, Tim Faust.
[01:38:18]  And I'm sorry.
[01:38:20]  I didn't mean to interrupt you.
[01:38:22]  You did, though.
[01:38:22]  I thought you usually stop talking after you say your name.
[01:38:26]  So I.
[01:38:31]  And we're joined by our producer, Young Chopsky.
[01:38:33]  My apologies to Liz once again.
[01:38:36]  Yes.
[01:38:36]  Thank you, Brace.
[01:38:37]  I accept your apology.
[01:38:39]  Thank God.
[01:38:40]  Thanks, guys.
[01:38:41]  Bye.
[01:39:02]  Come in.