The Complete Moderate’s Guide to Healthcare
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The Complete Moderate’s Guide to Healthcare

A fake Youtube chef cut his hand in the kitchen…
this is what happened to his wallet. KB is a 25… ish year old Youtuber, presenting
to the emergency room – which was a huge financial mistake. This video was brought to you by CuriosityStream. My original plan for this video was to take
that scenario through multiple different healthcare paths to show you all the options and costs. I very quickly realized that wasn’t going
to work. Even if I had done that, those numbers would
have been completely meaningless to you because of how healthcare works in our country. It’s not like ordering a Big Mac. The numbers I would’ve given you would only
apply to other 25-ish year old men living in [HARM TO ONGOING MATTER], it’s very unlikely
that it would be relevant to you. So there’s really no point in digging up
those numbers. Especially since the cost of a procedure not
only varies widely within the same city, but sometimes on the same block. A few stitches can cost anywhere from $200
to $3000. I picked stitches because it’s pretty universal,
there is no gender, or race, or even class, that is more prone to needing stitches. I’ve personally needed stitches at least
five times that I can remember. The obvious explanation for that wide range
is where on the body were you injured? Stitches on your shin are going to be easier
and cheaper than stitches on your eye. Except… no, some people pay less for eye
stitches. And these price ranges exist across the board
for all procedures, if you walk into a medical facility with a burst appendix, it’s going
to cost you anywhere from $1500 to $180,000. I somehow doubt that one appendectomy could
be 120 times better than another. Some cases are complicated and require extra
imaging or post-operative care, the point is, you don’t know that beforehand. When you get the bill, it could be anywhere
in this range. So rather than just shouting numbers at you
and laughing about how ridiculous things can cost, I want to explain why that range exists. Many of you likely know parts of the answer
already. The most obvious being that urgent care is
almost always cheaper than emergency care. Both with and without insurance. Urgent cares are a relatively new concept
in the US and provide a cheaper alternative for non-life-threatening emergencies. Like stitches. Let me be clear, when in doubt, go to the
emergency room, you will never be turned away, but if you walk into an urgent care with something
more serious, they might send you to the ER, possibly delaying lifesaving treatment. But odds are that if you only need four stitches,
it probably isn’t going to kill you any time soon. Emergency rooms cost so much more because
of the infrastructure and overhead required to keep a large hospital running. But also because of more nefarious reasons. 70% of hospitals in the United States are
privately operated but not run for profit, which is surprising to most Americans. Insurance companies, on the other hand, are
only run for profit. So in order to attract more customers, insurance
companies have to offer better deals. Which is somewhat difficult when a hospital
is non-for-profit. Usually, if you’re not making a profit,
it means your prices are already as low as they can be. Enter the hospital chargemaster. That’s not a chargemaster. Pretend. Every hospital in America has a list of prices
for every good and service they provide, which until this year, was kept hidden from the
public. Which is a huge problem in a capitalist system. You can’t really make an informed economic
decision if there is no price transparency or easy way to compare different costs. Not that you would ever shop around during
an emergency anyway. So the insurance companies went to the hospitals
– Side note, in some cases, the insurance companies own the hospital outright, and while
the hospital is a non-profit… they aren’t. – and said “hey, you’re currently charging
your customers $200 for this service, why don’t you increase your chargemaster price
to $250, but still only charge our customers $200, that way we can tell them we’re getting
them a discount.” This should sound familiar to anyone who has
ever shopped on Black Friday. Repeat that for every procedure or medication,
nationwide, and you have the first piece of the puzzle. When figuring out the cost of healthcare in
the US, you have to look at multiple variables, we’ll add to this list as we go, but we
can start with the base cost. The price of materials, labor, facilities,
and sometimes including those blue light chargemaster rollbacks. As we’ve seen, this base cost can range
from three to six digits depending on where you go. Which is the second variable – location. Not only are we talking about state or city,
but street. Add in provider type – are you going to
an emergency room, urgent care, or just your doctor – and you have even more variation. Since we’re only five minutes in, you probably
figured out that this list isn’t even close to complete. An unfortunate reality of our system is that
it also matters who you are. The Affordable Care Act made it illegal for
hospitals and insurance companies to charge you differently based on your previous medical
history, but they can still charge you differently for basically any other reason – including
gender and perhaps most obviously, your age. For example, stitches on an infant are objectively
more difficult and therefore more expensive. Bet that wasn’t the direction you expected
me to take the ageism argument. Procedures aside, age is one of the biggest
factors that contribute to the cost of health insurance. Alright non-Americans, get your laughs out
of the way now. [Laughs in Foreigner] Health insurance started
as a sort of membership program, known as Health Assurance, you paid a fixed amount
every month and any medical costs you incur were on them. Your health was assured. It didn’t take them very long to figure
out the formula for success. Obvious abuses aside, that simple just model
wasn’t sustainable. So over time, they have shifted more of the
cost of actually using medical services onto the consumer, called it Insurance, and made
the system so complicated that most Americans don’t even bother trying to understand it. Lucky for you… I’m not doing anything, I’ve got time. The health insurance industry didn’t really
take off until World War 2, along with rationing fuel and rubber, prices and wages were also
fixed by the government. So companies had to get creative to attract
talent. The most popular way was to offer benefits
on top of your salary, like paid vacation, housing, or health insurance. Today, 60% of Americans get their health insurance
through their employer. This is thanks, in part to ObamaCare, officially
known as the Affordable Care Act or ACA, which made it so that any company with at least
50 employees has to offer health insurance. Though “offer” is a bit of a loose term. Which is yet another factor – how much your
employer offers to contribute. Your insurance premium might be $500 a month,
but your employer might only pay half of it… or none of it. In order to discuss how insurance actually
works, let’s take a look at something a little more simple – car insurance. In most states, if you own a car, you are
also required to have car insurance. The more people who are paying into insurance,
the lower the cost for everyone – most people accept this reality when it comes to car insurance. But not health insurance, for some reason. The Affordable Care Act did a lot of good
things, like mostly getting rid of pre-existing conditions, allowing you to remain on your
parents’ insurance until you’re 26, and a bunch of other stuff we’ll get to later. But it also required everyone to have health
insurance, through the Individual Mandate. The hope being that the more people who have
insurance, the cheaper it will be for everyone, just like car insurance. But the mandate was just repealed so, never
mind, I guess. Everyone with insurance pays a premium, this
is like your membership fee and you pay this regardless of whether or not you actually
use it. If your premium is $100 a month and you never
get into an accident, that $1200 a year is simply gone. Because of this, a lot of people think of
insurance as a bit of a scam – If I didn’t use it, I should get it back or something. This is what I’m going to call Stage Zero
– you pay your premiums, you don’t use it, and nothing happens. Rinse and repeat, every year. There are two tiers of car insurance, the
lowest being Liability, which only pays out if you are at fault in an accident, and Comprehensive,
which pays for any damage to your vehicle, whether it be a collision or an act of god. But once you actually have an accident, you
enter Stage One, when you pay all costs out of pocket until you reach your deductible. This is the amount you have to pay before
your insurance will contribute. For many car insurance plans, the deductible
is also your maximum out of pocket – or MOOP. Who the hell is Moop? It’s the most you will pay to fix your car
in a given year. After which, you enter Stage Two, when your
insurance pays all remaining costs. Sometimes, there is a maximum annual or lifetime
benefit, after which you would be on the hook for any remaining costs, but that’s fairly
rare. So if you get into an accident that costs
$15,000, you would only pay up to your deductible, say five hundred dollars, and your insurance
company would cover the rest. Congratulations, having car insurance probably
saved you thousands of dollars. But when it comes to health insurance, most
people only focus on the cost, if they never go to the doctor they’re just throwing away
money every month. This is important, so pay attention. Not having insurance is only cheaper, if you
know that healthcare costs without insurance will be less than your annual premium and
your deductible put together. Remember, without insurance, you will be paying
regular chargemaster prices. Some hospitals might be willing to work with
you and give you the “discount” price if you’re uninsured, but you can never count
on that. For our car insurance example, that tipping
point would be $1700. If you know that your car repair costs are
going to be less than $1700, it’s cheaper to just go without insurance. But you literally can’t know that. You can’t predict if some if some random
tire is going to hit you. Just as you can’t predict if you’re going
to cut yourself or your appendix is going to burst. So let’s say you’re playing it safe, you
have health insurance, and something unpredictable happens… Just like car insurance, you started in Stage
Zero. You’ve been paying your premiums and have
been relatively healthy until now. You go to the hospital and you enter Stage
One, you are paying everything out of pocket up to your deductible, so far everything is
pretty simple. But Stage Two is where things become a bit
more complicated – this is when you and the insurance company split the costs of your
care, through two mechanisms. A copay is a flat fee, like $25 every time
you go to the doctor. That’s just to walk in the door, by the
way, if they do anything more than that, it costs extra. Usually through coinsurance, which is a percentage
rather than a flat fee, so for example, 20% of all outpatient procedures. Only copays and coinsurance count towards
your MOOP, premiums, prescriptions, and out of network costs, do not. Once you hit your maximum, you enter Stage
Three – when your insurance company covers all remaining costs. The Affordable Care Act prohibits any maximum
annual benefit or lifetime limits for health insurance, though they can still exist for
dental and other insurance types. So Stage Three has no maximum dollar amount,
but your MOOP is annual limit that resets each year. This is the next variable we’re going to
add to our list – When the healthcare cost occurs. If your appendix bursts with only one month
left to go in the year and you hit your maximum out of pocket, if you still need continuing
care the next month – which is also technically the next year – you will have to pay your
maximum out of pocket again. Effectively doubling the cost of this single
event even with insurance. There are many different types of health insurance
programs, all of which cost different amounts based on what kind of care you want. Or more likely, what your employer chose for
you. The cheapest type is an HMO or Health Maintenance
Organization which operates through smaller networks of providers. Another very important term and concept. Doctors and hospitals sign agreements with
insurance companies to be part of their network and see their patients, sometimes at a reduced
rate, as I mentioned earlier. If you’re on that insurance, you can only
see those doctors and hospitals. If the doctor or the insurance company decide
they don’t want to work together anymore – you don’t get a say. If you like your doctor, or health plan, you
can keep your doctor. He couldn’t legally mandate that your doctor
and insurance company continue to work together forever – this is America. So now your doctor is out-of-network. If you see an out-of-network doctor, you will
very likely be on the hook for the entire, non-discounted bill. And you might not know it until afterwards. It’s not uncommon to go to an in-network
hospital and be seen by a prohibitively expensive out-of-network specialist at that hospital. HMOs typically have lower premiums up front,
but higher out of pocket expenses later. Everything is routed through your Primary
Care Provider, they make decisions about your health and you can’t see a specialist without
a referral or pre-authorization from your insurance company. That doctor acts as a gatekeeper for your
healthcare… which would make the insurance company the keymaster? The other end of the spectrum is a PPO or
Preferred Provider Organization, where you don’t have a primary care provider deciding
on what specialists you see or what care you receive. The premiums are higher but the out of pocket
expenses are lower. They typically have a larger network than
HMOs and out of network care is significantly cheaper, you don’t need a referral or pre-authorization. So it costs more to have more control and
more choice in your healthcare. That’s how capitalism works right? More choices and competition leads to higher-
wait… And then you have all sorts of programs in
between. Like the Exclusive Provider or EPO, which
is similar to a PPO, but out of network costs more and you might need pre-authorization
to see a specialist. Then there’s Point of Service, which is
like an HMO but out of network costs less and nobody abbreviates it. It’s a mess and even the definitions I just
gave you vary from company to company and state to state. But in general, those are your options, yet
another variable to add to the list. But wouldn’t it be great if we could just
cut out the middleman and pay for our own health care? Yeah, or you could- Shut up this is America. Some people have the option of getting a High
Deductible Health Plan or HDHP, which have extremely low premiums and extremely high
out of pocket costs. But it unlocks the ability to create a Health
Savings Account. An HSA is very similar to an IRA retirement
account, any money you pay into it is tax free and as long as you only use it to pay
for your insane healthcare costs, it doesn’t get taxed on the back end either. But wait, it gets better. Just like an IRA, you can invest your HSA
money, growing it potentially infinitely… which you also don’t have to pay taxes on. This is why they call them triple tax shelters. If you’re like me, you’re already googling
how you can open one of these up, and I’ve got some bad news for you. You can only open an HSA if you have an HDHP. If you’re on any other form of health insurance,
or even no insurance, this option is not available to you. And unless you’re perfectly healthy, that’s
probably a good thing. The astute amongst you will have noticed that
I haven’t given you any numbers for these programs… and there’s a reason for that. Not all HMOs and PPOs are created equal. Another good thing the Affordable Care Act
did was to establish a standardized tier system for health insurance, so people looking on
the marketplace can actually price compare and shop around. The absolute lowest level is called Catastrophic
insurance, these are typically your HDHPs, gamblers who are saving up their money and
hoping they never get sick or end up in a car accident. That’s about the only thing these plans
cover – emergency services. In America, all health insurance plans, regardless
of type or tier, cover emergency services in- or out-of-network. Though once you’re stable you better leave
that out-of-network hospital or the bill will give you a heart attack. Which just repeats the cycle. Catastrophic plans are like only having liability
insurance on your car, it really only helps you in the worst of situations, otherwise
you’re on your own. You also have to be under 30 to get it, which
means it doesn’t apply to me anymore so- I mean, it does apply to me for the next five
years. The four main tiers of the Affordable Care
Act are bronze, silver, gold, and platinum. The better the metal, the more you pay in
monthly premiums, but also, the lower your out of pocket costs when you actually receive
care. The ACA defines these tiers by the average
coinsurance for the plan, they call this the actuarial value. For Bronze, the actuarial value is 60%, they
pay an average of 60%, and you pay 40% in coinsurance. In Platinum, you pay 10% and they pay 90%. Again, this is the average, for some services
it might be 92% while others might be 85%. At the end of the year you might find that
you actually paid 11%. The actuarial value is the only definition
for the tiers – premiums, deductibles, and MOOPs can be all over the place. There’s really no way for me to compare
a Platinum HMO to a Silver PPO or a Bronze POS. Making this another determining factor in
your overall healthcare costs. But for the sake of an example, let’s just
pick one: gold. The average monthly premium for a gold-tier
plan is $597 a month for an individual and $1252 for a family. The beauty of family plans is that it usually
costs the same whether its two people or seven. If you’re getting a gold plan through your
employer, they might be paying for some of it. If you got it through the health insurance
marketplace,, you might be getting subsidies to help. But for our purposes we’re just going to
stick to the base cost. So, let’s say you need those $3000 stitches. An individual gold-plan deductible can range
from $1000 to $5000, but the average is $1320. Remember, you pay that much before insurance
even kicks in. The remaining cost is shared between you and
the insurance company at a 20-80 split, only costing you an additional $336. The average individual gold plan MOOP is $5878,
so we’re not even coming close to stage three. In the end, those $3000 stitches cost only
$1656, just over half, wow, it’s a good thing you had insurance… You forgot ab-
Son of- yeah, as most people do, I forgot about the premiums. On top of the stitches, you paid $7164 in
premiums, bringing your total health care costs for the year to $8820. Here’s the same scenario for the average
gold family plan. As I’ve said, it’s impossible to know
whether an uninsured person with the same $3000 injury would fair better financially… But it is possible. And while the person writing the $1600 check
while paying monthly premiums is going to feel a lot more financially secure than the
person cutting $3000… The economic realities of healthcare costs
in America don’t care about your feelings. Now, I picked gold as an example because it
has an actuarial value of 80%. Which is the exact same as Medicare. Medicare is a socialized health insurance
program that covers 59.9 million Americans, most of which are over the age of 65. It is the largest single provider of health
insurance in America. I briefly covered Medicare and how it’s
funded in my video on welfare, along with another program for poor people called Medicaid. Medicaid is run at the state-level. So while it covers 74 million people, they’re
spread across 54 different state and territory programs that all set their own requirements
and pay outs. A single person in Alabama must make less
than $771 a month to qualify for Medicaid. The average panhandler makes $25 a day begging
for money on the corner – if they’re out there every day this month… Maybe take Halloween off, is all I’m trying
to say. Medicaid benefits depend on your income level,
at the lowest you’re paying single digit copays and at the highest, 20% coinsurance. Just like Medicare. But while Medicaid is a complicated welfare
program, Medicare is not. It’s government-subsidized health insurance. Every American who works pays into it with
a 1.45% FICA tax, which is also matched by your employer. If you contribute for ten years, you get full
Medicare when you turn 65. Medicare is not free, it’s also not simple
– but since it currently covers 20% of all Americans and presumably will cover all of
us once we’re old enough, it’s worth looking into. I need to start by saying that this is just
an overview. Most of my audience is several decades away
from Medicare, so if you’re currently in the process of enrolling, please speak to
a professional, this is just an introduction. There are entire channels dedicated to explaining
Medicare – we’re just going to scratch the surface. Medicare has four parts. Part A is for inpatient services like overnight
stays at a hospital. For the vast majority of people, there are
no premiums for Part A. But there is a $1364 deductible and a complicated copay and coinsurance
table. Medicare Part B is for outpatient services
like regular doctor visits. This does have a monthly premium for most
people, but before I tell you what it is, remember that you’re getting an actuarial
value of 80%. $135.50 a month – regardless of who you
are. But we’ve learned that low premiums usually
equate to a high deductible so- $185 deductible. So because stitches are usually an outpatient
procedure, we can figure out that those $3000 stitches would cost you $748 out of pocket. And $2374 a year in total expenses. There are no family plans in Medicare, it’s
just for the individual retiree, and these are by far the cheapest stitches we’ve come
across so far. But there is a catch. Medicare Part A and Part B, collectively referred
to as Original Medicare, have no maximum out of pocket limit. You pay the same 20% coinsurance to infinity
and beyond. Which is why we need to talk about Medicare
Supplement Plans, also known as Medigap plans. These add a MOOP, as well as reducing your
coinsurance. This is an addon run by a private insurance
company that doesn’t get to decide what or how much they cover, that’s dictated
by Medicare. They do get to decide what to charge you though. Alternatively, you can scrap Original Medicare
altogether and opt for Part C – better known as Medicare Advantage. This is a private insurance plan that takes
the place of Parts A and B (and sometimes D) and acts as its own supplement, so you
get a MOOP. You pay your premiums to them, rather than
Medicare. Now the insurance company gets to make decisions
about your healthcare, instead of the government. And it is required to give you that same 80%
actuarial value… in theory. In practice, the HHS Inspector General recently
found that 56% of people on Medicare Advantage were denied necessary treatment simply for
monetary gain. I know, right? I was just as shocked as you. About 36% of people eligible for Medicare
opt for Medicare Advantage, so when you hear someone complaining about Medicare… There’s a decent chance they’re not actually
on Medicare. And I’ll give you one guess as to which
Part ends up with the most waste, fraud, and abuse… It’s actually Part D, which is your optional
prescription drug coverage – but before you get mad at me for the bait and switch,
both C and D are run by private insurance companies. I’m not kidding, Part C and D waste, fraud,
and abuse is rampant, you can find the powerpoint presentations from HHS online. The problem is that when the news tells you
about Medicare waste, they usually leave out which Parts are causing that. And when they talk about healthcare statistics,
they neglect to mention that a third of the people are actually on private insurance. The 59.9 million number I cited earlier is
Original Medicare and Medicare Advantage put together. There are 44 million people on just Original
Medicare. And 90% of them don’t use Medicare exclusively,
they get a Medigap supplement plan or a Part D Prescription plan, or both. Prescriptions aren’t usually covered by
health insurance. Even in countries with universal socialized
medicine, dental, vision, and prescriptions are usually separate. And prescriptions drugs are even more of a
mess than healthcare. Each Part D plan has a list of prescriptions
they cover called a Formulary, you’ll need to look over that list when choosing your
plan. I hope you accurately predicted what medicines
you’ll need in the future. Americans pay the absolute highest prices
in the world for medications, sometimes by an order of magnitude, and the main reason
is somewhat counterintuitive. The UK has a single payer system known as
the National Health Service or NHS, every British citizen is covered for almost no out
of pocket cost. A total of 66 million people. The government negotiates prices with drug
companies, knowing that they will be the only supplier of that medication to 66 million
people. So they get a pretty good deal. There is no equivalent in the US, the government
doesn’t negotiate or even really regulate prices – the best we have is Medicare with
44 million people. And there’s a reason they pay the least. Counter to the common capitalist perception
that competition and choice drive down prices – at least when it comes to healthcare – market
share seems to have much more influence. The more people you are negotiating on behalf
of, the lower your prices. But also, it costs a lot of money to develop
treatments and medications, so most companies want to make the largest return on investment
as they can. But when you’re selling to the UK and Germany
for such low prices, where are you going to make your money? The country that isn’t negotiating on behalf
of 320 million people and has little to no regulation regarding price ceilings. Why do they charge so much? Because they can. The common argument against adopting a system
like the UK is that they are incredibly overtaxed. So let’s get our calculators back out and
check. The median household income in the United
States is $59,039, assuming just the standard deductions for a single person, you would
be paying $10,804 in federal taxes – both income and FICA. I have a video all about income taxes if you
want to know the actual math behind that. If you took that same income and went to the
UK, after converting to pounds and then back again, you are paying $14,451 in national
taxes. This includes your income tax and the National
Insurance tax, which is like our Medicare tax but, significantly larger. Side by side, if you make the median household
income in the US, you are paying 18.3% in federal taxes, if you took that to the UK,
you’d be paying 24.5%… but remember, healthcare is included. If you want healthcare in the US, the average
annual employer-based premium across all types and levels for an individual is $6896 a year. So in reality, you’re paying 30% of your
income in taxes and health insurance – and that’s not even considering what happens
if you actually get sick. In the interest of being thorough, if you
double the median income to $118,078 and were married with two kids – you would be paying
significantly more taxes in the UK. However, your healthcare expenses don’t
really change, whereas the average employer-based health insurance premium for a family is over
triple that of an individual. So a US family is still paying more in taxes
and healthcare – even if they never go to the doctor. The UK does have a Value-Added Tax, or VAT,
of 20%. But their cost of living is about 7% lower,
so once you consider sales tax in the US, prices are pretty comparable. A Samsung Galaxy S10 costs about $15 more
in London than New York. And a Big Mac is a dollar fifty cheaper. The quality of these products are pretty much
the same wherever you go, but for some reason, we insist that US healthcare is the exception. That has to be the last variable on our list,
American stitches are just inherently better than UK stitches. No, most people already know this, but the
UK, Canada, Australia, and most other industrialized countries beat us in just about every healthcare
metric. Life expectancy, infant mortality, maternal
mortality, the list goes on. But generally, these numbers are close enough
that you can say that the US is basically on par with everyone else. But per capita, we’re paying double what
they are. Objectively, the UK does have longer wait
times, from a few more minutes in the ER to a week or two for a specialist. But I want to challenge your assumptions here. If waiting a little longer drastically reduces
cost, but doesn’t negatively impact healthcare outcomes… How important is it to be seen right now? Can you zoom in and say the US is better in
a specific field like heart transplants or post-op complications? Sure, but overall, we’re not getting what
we’re paying for. Which is why we’ve been arguing about how
to change this system since forever. But we might actually do it this time. I’m obviously not going to talk about all
of the proposals, because you’ll never hear from most of these people ever again. So let’s just focus on two. Mayor Pete is proposing a Medicare opt-in
plan or “Medicare for all who want it.” This is just a reskin of the classic “Public
Option.” This would open up Medicare to anyone, if
you’re uninsured, you’re automatically on it, if you get health insurance through
your employer, you can switch, but otherwise nothing changes. Unless your employer wants to switch to Medicare,
in which case you don’t have a choice. It would also make a few smaller changes like
adding a Medicare MOOP and capping out-of-network costs. Most people wouldn’t see any changes to
their healthcare. Which isn’t very exciting, so let’s talk
about the plan you all want me to – the Medicare for All proposal from Kristen Gillibrand. She’s not even running anymore. You won’t let me just have- Fine, let’s
talk about Bernie Sanders. Bernie’s Medicare for All plan would basically
turn our healthcare system into the UK’s, with a single payer government health service. But with dental, vision, and prescriptions
included. Like the UK, there would be no premiums and
little to no out of pocket expenses. It also abolishes private insurance. No more employer-based health plans, no healthcare
marketplace, no deductibles, no premiums, no channels completely dedicated to demystifying
Medicare. You and your doctor will make decisions about
your healthcare, not a private corporation. Instead, the government would be the third-party
payer. How they would pay for this is always a point
of contention and oftentimes the question is intentionally worded poorly. How much are your taxes going to go up? And you said… How much are your costs going to go down? No, different question, how much will your
taxes go up? No, it’s how much are your costs, because
it’s- This sounds like a dodge because she’s trying
to reframe the question. Taxes will go up, primarily for the wealthy,
but likely the middle class as well. But remember, even if your taxes went up by
50%, the fact that this expense no longer exists means you are still better off – and
you won’t pay much more, if at all, when you need medical care. This would also reduce the overall bloat in
our system that contributes to the high cost. Your HR person has to pick a health plan,
hospitals and doctors need to hire special billing coders, the insurance company needs
claims specialists, and youtubers need to make videos explaining it all. I’m positive we can do better than this. But if you insist on keeping your healthcare
expenses unnecessarily high, even under the proposed Medicare for All, might I suggest
getting into vitamins and supplements? An industry you can learn all about by going
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without worrying about algorithms and demonetization. My channel, as well as many of your other
favorites, can be found there, including several original series. By joining CuriosityStream and Nebula, you’ll
also be supporting the channel. Full disclosure, I have no horse in this race. I am a service-connected, disabled combat
veteran, I get my healthcare through the Veteran’s Affairs hospital – which isn’t a health
insurance program. It’s a self-contained system and a bottomless
well of asterisks. So I’m not complaining about the system
and talking about proposals for change for my personal benefit. I also had no reason to give myself all that
math homework. It took me a month of daily research to figure
all of this out and present it to you and that alone should tell you this is overly
complicated. Luckily, I don’t do anything else with my
time. So now, as you’re watching debates about
taxes and reading news articles about rising premiums, you’ll actually understand what
they’re talking about, because now, you know better. If you hadn’t noticed, I made some improvements
to the set, so if you’d like to add your name to the chargemaster, head on over to, or for a one-time donation, Don’t forget to copay that subscribe button,
check out the merch at, follow me on Twitter and Facebook, and join us on
the subreddit.

About Bill McCormick

Read All Posts By Bill McCormick

100 thoughts on “The Complete Moderate’s Guide to Healthcare

  1. In the interest of being a Moderate's Guide and covering bOtH SiDeS – the Republicans want to keep things the way they are… maybe even privatize them more.

  2. Jesus H Ballcrushing Poopsickle Shitstick! WTH is this system?? This is some… Kafka-levels dingbat insanity!!

    Why in ungodly hellholes do you guys put up with this??

    Here in communist Denmark, we go to the doctor, and then we… nope, that's it!

  3. Hey KB. When comparing living costs in the UK, don't choose London. The cost of living there is far higher than the rest of the UK. Choose an average post industrial UK city like Derby for example. That's the probable average in the UK. Otherwise great video.

  4. Car insurance is a God damn scam…any insurance is a fucking scam.

    I had a 1996 Corolla in 2015…I was paying state Florida minimums at the time when I had a not at fault accident that totalled my insurance company involved would pay to repair my God damn car…if I had saved up all the money I had paid to my insurance company (about 3 years worth at $50 a month) I could've paid for my repairs.

    As far as health insurance there was a 6 months period where I was employed and making $8.25 an hour, 40 hours a week and I got a health insurance plan that cost me $60-$70 a mo through my employer which had like a $2500 deductable on it….usually when I went to my therapist they gave me a pay scale option because I made $8.25/hr which cost me like $20 per session, but since I got health insurance, they told me I wasn't eligible for the pay scale…and j had to pay $75 for the whole session. Fuck you and your insurance…it's a fucking scam. I paid the mandate in 2017 because American neoliberalism; I just don't ever go to a doctor now, and pray if I get into a car accident it kills me before I get the bill.

  5. Are you going to talk about the LDS church, The Church of Latter-day Saints, aka Mormon, any time soon? I have loved watching though a majority of your videos and have noticed that you seem to touch or at least make light of them and some times jokes. But then you never seem to dive any deeper into it. Be it a video over relation, doomsday sayers, the geology of the u.s. and her states, etc. you always without fail to make some kind of reference about them, but haven't done anything as of yet.

    For all, I know you could be working on a video right now about it and just haven't published it yet, seeing how you were making reference to color in a 2016 vid and didn't get around to publishing that until 2017. I'm just curious about what your views are on it seeing how I was raised one and don't really want to be one anymore due to many reasons.

  6. Here in Brazil we have a Universal Healthcare System (SUS – Sistema Universal de Saúde), is it shite? Most of the time. Do people die in the waiting room? Sometimes. Does anyone go bankrupt because they needed treatment to save their life? No.
    Brazilian's public healthcare is bad, but it works and it saves lifes

  7. Health care insurance problems are from the disassociation of the consumer from cost. The consumer does not care of the cost of services and the hospitals charge what ever they want to the insurance company. Socialism is theft and immoral no mater how you try to justify it.

  8. This video finally got my head around the labyrinth of US healthcare.

    I am subscribed to the channel now. Your videos are great.

  9. This is one of the most frightening videos I have ever watched. I live in England. Our government wants to move to your system and dismantle the NHS.

  10. An urgent care almost killed me. I was suffering from dehydrating and they sent me home with what was basicly a flu shot. Thankfully the next day my mom took me to our doctor and immediately she said "get her to the hospital NOW" Urgent cares can be dangrous so becareful

  11. SPECTACULAR video, KB. I've known for a long while that our health insurance/health care system sucks (self-employed take it on the chin even more than the figures you gave, believe it or not), but getting to see it layed out and organized the way you did filled me with true awe (and disgust) at how convoluted and (excuse the language) fucked up this racket has become. Never thought my conservative ass would say it: bring on the universal health care. This mess needs to get cleaned up.

  12. "Waiting a week or two for a specialist" this is wrong, try 3-12 months for anything that isn't immediately life threatening in a public system. I basically have to pay for private specialists out of pocket where I live because the public system is so overloaded. Unless you're physically in a hospital ward dying, you will be put on a wait list, if not getting rejected outright because your doctor didn't make your condition sound dramatic enough. I would absolutely prefer to be in the American system than my current one, I don't think Americans understand how rare it is in the rest of the world to be able to see someone when you need to, or being able to access treatments that aren't just based on what's cheapest or easiest to fund.

  13. My experience with the US healthcare system:

    In my 20's I worked for my states government so I had PEIA (Public employee Insurance Agency) which was 80/20 coverage with a $800 yearly deductible, and I paid $300 a month ($150) out of every check that the state matched to pay for that insurance plan. 80/20 means that any medical bill i was charged, after $800 dollars I paid, the 80/20 percentage would kick in. So if I had a medical procedure done that costed $10,000, I would be required to pay first $800 out of my own pocket, and then the 80/20 would kick in so the insurance would pay 80 percent of the total $9200 and I would have to pay the rest. In the US an emergency room visit can cost thousands of dollars. If you are taken to the emergency room in an ambulance, in my rural area, that price starts at $1000 a ride. WIth all the tests they have to do on you, xrays, and any meds they give you (children's aspirin is $500 in the emergency room)

    Then in my 30s I worked for a coal mine and had what Obama called a "Cadillac insurance plan" which was- I paid no monthly fee, 90/10 insurance with a $500 yearly deductible. I had the first plan for 7 years, then I had the second plan for 7 years. This insurance plan also took care of my states welfare recipients. People on welfare in my state received 100 percent coverage. Their children also had 100 percent coverage. In which no matter what procedure they were having done, the state paid 100 percent of the bill. (THIS is why I always questioned Obamacare.) If the state deemed you able to work and unfit for Welfare, then it was your responsibility to find a job that offered the benefits you desire.

    Then, Obamacare came into play, my insurance went from great to pisspoor not worth having, and I, who worked in a coal mine, that worked 60 to 80 hours a week because I didn't want to be a leech on society, started seeing 18 year olds with "bad backs" on welfare doctor shopping for pills in the emergency room acting like they were dying, while I had a broke wrist that my insurance wouldn't pay for. When you see the Welfare and social security deem a fat ass 300lb lazy 18 year old that never worked a day in their life "unfit" to work and given a SSI check and welfare check, that really disgusts people like me.

    The thing is, you don't use the emergency room unless it's a real emergency. You go to a clinic and it won't be as expensive as the emergency room. If you are an adult you should have medical insurance. Period. It's just like vehicle insurance. If you drive, you have to carry it. The reason everything is so expensive, it's because there are so many people that don't have insurance, so the hospitals have to make up for the deadbeats out there that use their services and never pay the bill.

  14. 24:32 – Does anyone have a link to this webpage where you can compare U.S. drug prices to those abroad? I looked for it in the description but didn't see it.

  15. So Capitalism has helped to make healthcare cheaper (For innumerable reasons) but one of which is the creation of urgent Cares? That's great and we should continue the advancement of smaller, more cost effective forms of healthcare.

    Socialism is not the solution for this. Capitalism has brought affordable cares to the poorest parts of the world, we can do the same for healthcare.

    The government regulated competition in Healthcare and created the monopolist system of insurance.

    PS: So the United States is at least in part paying for the healthcare of Europe… Nice.. There is a Reason why the US leads in Medical Innovation. Socialism is what you wan't if you want to sit still and stagnate but even then you're only comfortable because in one way or another half of your National budget is subsidized by the US Tax Payer be it defense or paying for Medical R&D.

  16. 22:53 I think the IG was referring to cases when the insurance will cover so little of the cost and set copays have to be acknowledged that the company issuing the service or medication will eat a large cost. I worked at a pharmacy for 3 years and this happened many times, our boss wouldn't let us eat a cost of over like $100 and believe me that happened very often, we would even get loss amounts over a grand, sometimes over 10k! So when you say "for monetary gain" you're making them seem like the bad guy when in reality they're just trying to stay afloat just like the patient.

  17. Here in the UK we have NHS walk in to A&E (ER) say I have a boo boo get stitches buy coffee that tastes like dirt for £2 out the machine. Total cost of you're visit £2.
    Carry on with your vacation.

  18. I'm glad you spoke honestly on this. Sometimes to seem "moderate" people express both sides evenly. When discussing the Earth it is not moderate to gived equal weight to flat earthers. I'm proud of you because I'm sure a few twits are shouting that you were not being moderate.

  19. 1. Wait times are a lot longer, and in many cases it is when the conditions are severe (i.e. cancer), or you might just be waiting in line and get bumped back when somebody with more urgent needs comes in. 2. The life expectancy seems pretty good in the UK, but only because they don't count infant deaths. 3. Lastly, the government doesn't have the best track record when it comes to managing programs efficiently, effectively, and at a low cost.

  20. Why is your health a right actually interested in a response I agree that insurance companies have ruined it the answer is laws against insurance companies fraud not free insurance stop pretending capatilism is evil the problem is the lack of regulation in the hospital in socialism everyone would have equal shit cover I'm saying this as someone who gets free health insurance Australia has shit free health care you have to wait years for an important surgery so explain how free health care fixes anything I saw a kid with a stab injury at a hospital I could see his bone he had to wait 7 hours to see a doctor so a Complete waste of his parents tax money the kid was having a mental break down from the pain its literally useless

  21. P&C Insurance Agent here – I needed to correct you on something because I hate misinformation: while yes, liabilty does cover you if you cause an accident, it doesnt cover you personally. What it does is it keeps you from being sued for damages; it covers the other person's bodily injuries and property damage.
    Comrehensive DOES NOT cover collision. Thats what collision coverage is for. Comp is anything other than collision (in some states that's the actual vernacular) be it fire, theft, hitting bambi, or vandalism (flooding coverages varies from state to state). But there are actually three tiers: Liability (covers the other person if you cause an accident), coverages that protect you (uninsured/underinsured BI, Personal Injury Liability, medical payments etc), and then coverages that protect your vehicle (comp, collision, rental/roadside, underinsured/uninsured motorist property damage).

    Sorry, just wanted to clarify. Love your videos and definitely subbed!

  22. Correct me if I'm wrong, but doesn't the US also just let too few people graduate medschool, so you have too few doctors, resulting in inflated prices for their services?

  23. You are leaving out one thing. America has a much larger rural population. The quality of healthcare in southern Mississippi will be shittier than in NYC so to incentive doctors to Mississippi you have to pay more. I can't see the government doing that

  24. Explaining healthcare:
    US: Get your notebook and clear a week on the calendar, here it comes.
    Norway: It's free

  25. This is so confusing as a German… I pay a flat minimum of 180$ a month (max of 700 something depending on your income) but everything is covered- everything in ER – doctor visits-nearly everything in hospital- only dental is expensive, cause it is not 100% covered

  26. A big problem with America's healthcare is the administration costs, about 1/4 of your bill is from that. It's stupid and we need to fix it, as well as the other stupid problems.

  27. One thing you forget. The reason why other countries can have socialist medicine is because all the research is done in the United States. If the United States converted to a medicare-for-all system, medical research would be hampered greatly. Companies would be unable to make money off of the research and therefore it would come to a slow March. There are still some drugs that are used in the United States that are not used in Britain or are just arriving

  28. You also forgot about the larger waiting times in Canada. There is actually a Supreme Court case in Canada because a man was dying a cancer couldn't get treatment for the long wait and decided to pay for his own but was not allowed to by the state. He eventually won the right to do so but still lost valuable time.

  29. Bernie Plan will not totally eliminate Private insurance, it just wont compete with the same services the M$A will provide

  30. Says the guy who claimed that 4k will take another decade to catch on and 8k will never happen. Psh. Lol.

    Why the fuck should we listen to this self proclaimed expert of everything?

  31. If I get really sick I'll just put a 9mm through my head, there is no point in dealing with this corporate nonsense, I'm not enslaving myself with a 100k bill from the hospital…fuck that

  32. 6:10 rationing food, water, shelter and health

    28:45 stitches often scar less, because the US is vain and sometimes uses a different technique

  33. I think it would have been worth noting that in the UK and most countries with universal healthcare you still have the option of getting private healthcare if you can afford it – obviously, it might have complicated things somewhat but it's worth noting for wealthier people who are worried that the quality of their (very expensive) healthcare would go down and they wouldn't have any other options.

    This has its own benefits – if you need a hip replacement, for example, you could have had all your scans etc. on the NHS and then go private for the actual operation itself if you don't want to deal with wait times.

    I think giving people the choice to pay out of pocket doesn't affect the integrity of the healthcare system as a whole, because most people will still use the NHS for the majority of their healthcare and everyone has to pay into it withtheir taxes.

  34. For me I would like to see healthcare be thrown to the free market.
    With no regulation and vast competition for healthcare, instead of satisfying the insurance companies, the medical field would compete to give the best healthcare at the lowest cost.
    A great example is LASIK Eye surgery which is not regulated by insurance or government and is thus at the mercy of the free market.
    It started out, roughly 2014-2015, at prices of ~$10,000 per Eye and thanks to no regulation and the vast amount of competition it has dropped to around ~$500 per eye.

  35. See that LUCIFER poster behind him? Thats a dog whistle my friends. This guy is on that other shit. He knows why that poster made it into this segment.

  36. There are a lot of non profit insurance companies. They are called mutual insurance companies. Many of the largest US health care providers are non profit. He obviously didn’t do much research for this.

  37. Why are ALL of your videos being recommended to me? I DONT EVEN LIKE YOU! In my recommendations literally all of the vids were yours except 1.

  38. The video is well made, and certainly shows a lot of information on insurance, but making assumptions that free market doesn't lower the overall cost of healthcare based on US system is just plain misrepresentation of what's happening.
    There are better materials than this comment or this video about US healthcare system, but in short – it's not free market.
    You can lose medical license if you charge too low rates (not extortionate), and big pharma can charge whatever they can, because they have government immunity protecting copying the drug, which itself is against free private market. Ability to extend ridiculous 20 year patents is also at fault.
    This is the reason why healthcare professions in US have lots of highes paid jobs on the world (on average), whereas in normal countries, these aren't highest paid jobs on the market.

  39. Millennials don't want to die because they hate living, they just know they can't afford a near-death experience

  40. There is a massive issue with the private insurance argument…… no-one actually regulates the cronyism that capitalism had eradicated in all other areas (e.g. car insurance, there is no vehicle provider preference for example) you would need to argue that the advantage of the free market will be moot if you don’t apply the previous capitalism update of extracting the crony overcomplication

  41. dude, ya shoulda busted out an HerbaLife bottle when you brought up vitamins at the end.

    also, we need more ferret action in these videos 😎

  42. I remember when I still lived in Spain with my family, one particular year, my brother broke his hand and sliced a tendon down to the bone, I needed a series of complicated lung tests, and my grandmother needed three surgeries. None of us paid anything out of pocket.

    Fast forward a few years, me and my immediate family now living in the U.S., and my mother breaks her leg and requires a year of healing, regular visits, and rehab, and the financial strain it put on my family almost broke us and eventually contributed to my parents getting divorced due to the high amounts of stress it placed on the family.

    If that's not a broken system, then I don't know what is.

  43. Health insurance in the US is a full time job in itself. In the Uk we just go to the doctor and the doctor is boss – NO MONEY EVER MENTIONED – so much time saved and unnecessary pain avoided. We have private also but there's hardly any diff.

  44. I love these videos. I can't ever get too mad at them plus you have time to make a cogent argument w/o me interrupting.

  45. What is up with my youtube feed? Doesnt matter what Im watching, my feed is nothing but your videos and Ive never seen a single one ever. Like Im setting here watching videos about video games and all I get is this stuff.

  46. 30:20 I mean that’s not really true. I believe that under bernies plan you can still get a supplement plan, but companies can’t offer stuff Medicare already covers cause that would be fraud

  47. Leaving out the tax tables when comparing the US and UK tax bills makes this seem way less moderate. The UK tax rate goes to 40% once your income reaches ~$60K. It would make me much less smug if I was British.

  48. I think you have to agree on one major deal with breaker….Free for all? Even illegal aliens have 100% access? There is NO WAY that is possible without the system completely being overwhelmed and collapsing! Convince me otherwise!

  49. So… American healthcare insurance isn’t actually insurance? Hmm best not get insurance then 🤣
    Also the Obamacare Mandate screwed over the poor. They still couldn’t afford insurance but then had to pay fines for not having it. Source: girlfriend of 5 years.

  50. Everyone agrees that good healthcare should be a priority. Yet, behold the billions Americans spend on booze, illicit drugs, tattoos, vacations, gambling, pets, electronics, etc….. Maybe it's our priorities that need reform?

  51. This man is no moderate. If you've watched over 5 of his videos on any given topic, you know his political stance. You know which way he leans, and if you think I'm being dubious, you know he leans your way, bucko.

  52. You seem to put a lot of responsibility on the insurance company. The average insurance company profits are in the single digits, while it is still a lot, it's isn't then why you have co pays etc. People wanting the latest best treatments without taking personal responsibility for their health is why. One Cancer treatment can easily be more than you every paid into health insurance, simple math.

  53. I think the the problem is that the US is massive and a health care system of that magnitude might be disastrous for such size. Mexico has a Socialized Health Care system and it’s just a mess. Great doctors, but terribly under equipped and understaffed hospitals. Organizing tiny Finland or Netherlands, with a heavily centralized government is not the same as in the US.

    Americans fear that Social Health Care might mirror the DMV, so there’s a lot of minds to change if you want to show that a government can do it better.

    The solution to this would be to have a State run program, we often forget that the US government is a Federation. Washington shouldn’t be making decisions like health care by design.

    It is hence understandable that Europeans might laugh at how the US has no system, but that’s because they have smaller countries and centralized governments.

    Also it would be interesting to see if such system would work if the US would would just get rid of NATO. That would make Europeans pay more for their defense and give Americans more money for their Health Care.

  54. Hold up now, are ya critusiuzing AMERICAN healthcare!? That's bad! Bad! Bayud! Just laik Communism! Communism bayud, Capitulism guwd! This is the land of oppurtunitieh, only lazy unpatriotiodik losers git sick in AMERICA! U.S.A. #1!! Fires revolver into air while cheering loudly

  55. buy your own medical stapler from Amazon for $10 and you know what you pay If you need antibiotics order them from vet supply and the whole bill with 10 days of antibiotics is >$30

  56. Good video, but you really dont know the true story about places like Canada, which is where I am and have experience with. The quality in the US is dramatically higher. When you said you may have to wait a few extra minutes in the ER or weeks to see a specialist you couldnt be more wrong. The average waiting time for emergency I'm canada is about 3 hours and in some areas the average is as high at 8-12 hours. To get an MRI takes months. Seeing a specialist generally takes months to even years. I personally have had to wait over a year to see a neurologist for a serious medical issue. Half of canadians do not have a family doctor at all. If you need to get some antibiotics, stitches, an x-ray or it's an immediate emergency it works pretty well. But when it comes to anything preventative or testing it is almost completely non existent in Canada. Doctors here dont even do physical exams anymore because they take too much time and resources so they dont catch problems until generally it is an emergency. The system here is unbelievably broken and getting much worse. There are many problems with the US system, but many positives as well. Things could be much worse, definitely don't advocate for a system like Canada has though.

  57. why are these facts making me anxious
    i just got out of my parents house and watched this video, now i'm worried about my livelyhood…

  58. Maybe it's just me, but there isn't ONE comment in your comment section in disagreement and posing a rival argument. That seems to defy all odds. I'm not very educated about the healthcare system here or in the UK, but just from basic logic I understand that while there is definitely a cost benefit in negotiating from a higher volume of customers, there is also a cost disadvantage in taking on a higher volume of non-paying customers. If you make something free, more people are going to consume it. You need a certain amount of people paying, versus free-rider consumers.

    Another thing I noticed is that you just brushed past the notion of what insurance really is – as though pre-existing conditions shouldn't have any bearing. If you have a car that has been abused and is on the verge of breaking down, it makes ZERO sense for an insurance company or fellow members of society to take on the cost of maintaining that car. No auto insurer in their right mind is going to offer you cheap insurance for such a vehicle. If they did, they would quickly be out of business.

    I can't debate your numbers because I haven't done the same research, but from a basic logic perspective, you seem to have purposely avoided that which would go against your conclusion.

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