Ben Gilbert: commitment

Transcript context

…Who also, by the way, are the highest consumers of healthcare. So here we are in 1965. David, you’re exactly right. Medicare and Medicaid enter the picture as a part of the Social Security Act. How did we get here is interesting. FDR, Truman, and Kennedy had all tried to pass a single payer system the way that the UK did right after World War II. The UK is in this moment of great nationalistic pride. We all have to band together, look after one another. They pass the National Health System. The US does not have the political will to do it, so we don’t. You have this coverage gap, to your point earlier, of all these people who are not currently in the workforce. The compromise is we will create Medicare for those over 65 and Medicaid if you have a low income or other special situations. We can’t really fund either exactly right, so we’ll figure out how to fund Medicare out of the Federal government, and Medicaid, let’s make that the state’s responsibility. We’ll help, but we’ll federate that out to the states. So all of that is our system today. Private insurers, you have a job buying directly from the CA. If you don’t, but again, still from private insurers, Medicare or Medicaid if you fall outside those buckets. The important thing to realize from all this is that the vast majority of patients do not feel the cost of their healthcare directly in the United States. Those costs are so laundered through private insurance companies and Medicare and Medicaid, that most people think about any given health encounter as being paid for by someone else, by a part of some system. If you’re trying to unpack how did our healthcare become 18% of GDP versus 11% of the UK GDP or a staggering 6% of Singapore’s GDP, albeit at a much smaller scale, why are we 18%? A big thing you have to understand is psychologically every healthcare encounter is that the system is paying for it. I’m paying into the system, the system is paying for it, but what does it cost? What do I actually pay? It’s a big abstraction. In case it’s not glaringly obvious, why is this so important to medical records and the fledgling electronic medical record industry here? Because now, with these second- and third-party payers set up, you need documentation of what happened in order to get paid. If you’re a hospital or you’re a doctor or you’re a clinical practice before this system, you just see your patients and they pay you. Now, after this system, you see your patients and then you need to negotiate with the payer, whether that’s the insurance company or the government about getting paid for that. The insurance companies and the government, they’re like, well, hey, I need proof. I need documentation of what you did. I’m not going to pay you if you just tell me that you did this stuff.…

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