– [Obama] I happen to be a proponent. – Health care in the
United States of America. It kind of makes you feel like… Well… ♫ There’s no earthly way of knowing ♫ Which direction we are going ♫ There’s no knowing where we’re rowing ♫ Or which way the river’s flowing ♫ Is it raining ♫ Is it snowing ♫ Is a hurricane a-blowing ♫ Not a speck of light is showing So the danger must be growing. Are the fires of hell a-glowing? Is the grisly reaper a-mowing? Yes. The danger must be growing,
for the rowers keep on rowing, and they’re certainly not showing any signs that they are slowing. (screaming) Back in the early 1900’s, modern medicine was getting very good, at least compared to
what it used to be like. Uh, do you remember that
game, The Oregon Trail? It was pretty much like that. Lots of typhoid. The push to achieve
universal healthcare coverage started around 1912, not specifically with the run of Theodore
Roosevelt, but concurrently to. He was defeated and so
was a progressive campaign for sickness insurance
guaranteed by the states. This would be good to regard
as the beginning of the film where the good guy’s kind of defeated, you know, as a very
quick way of establishing that the bad guy is in fact very bad. Meanwhile, in the UK, they passed a bill that was not unlike the
Affordable Care Act. The National Insurance Act of 1911 was put into place in the United Kingdom 99 years before the Affordable Care Act was established in the
United States of America. This created a system of
health insurance based on contributions from employers, the government, and workers themselves. Meanwhile, in the US,
people relied essentially on employer-based sick funds
to help pay for medical costs. These costs continued to rise
until the Great Depression when no one had any money. Pretty much everybody,
including the hospitals, had shifted into should
I sell drugs now mode. And that’s when innovation happened. A hospital in Dallas, Texas
by the name of Baylor Hospital developed an insurance program
in which healthy people paid in case they got sick and then were essentially
covered from there. This program grew into what we know today as Blue Cross Blue Shield. Though the program was
operated as a not-for-profit, there are people in the
world that like money a lot. They realized that in a capitalist society that piece of paper with
a number on it is power. And because of the fact money is power, there is no better way to gather power than to find a necessity
and charge money for it. For instance, there was a
time in the United States where if a fire broke out, the
local private fire department was under no obligation to fight the fire, but they would if the
owner of the building that was on fire was an
insurance subscriber. But that was back in
the 1700’s where things were barbaric as hell. We wouldn’t do anything like
that here in modern times. So anyway, back to the history of our hundred year old
for-profit healthcare system. The American Medical
Association, the health lobby, really didn’t like the law that got passed in Great Britain and slandered it here. There were ad campaigns, op eds, you know whatever they did
back then instead of tweet. Essentially, they put out
a lot of information saying it was a bad idea. If the government is somehow involved in the providing of healthcare, then you will have no choices. Now keep in mind, the healthcare program we’re talking about was a
combination of employee, employer, and
government-provided healthcare. Money came from all
aspects, private and public. There were, in fact,
companies turning a profit in this system, but even this was too much for the health lobby, who spent lots of money lobbying for the special interest that is the healthcare industry. This is the part of the documentary where I’m supposed to
say, “And partied hard.” If this were a higher budget production, we would now cut to a montage
of all the opulence and excess that goes along with those
who sling money for a living. Ah, to be a lobbyist, one
whose sole responsibility is to ensure that politicians
are having a good enough time to do whatever it is that you ask them to. Just having fun trying
to get a corporate agenda executed at the state level. Instead, here’s some footage of me attempting to flush two
cucumbers down a toilet. In 1951, the IRS declared group premiums paid by employers to be a tax
deductible business expense. This was, perhaps, the biggest step to cementing third party
insurance providers’ place as the primary providers of health care in the United States. And I’m sure this had nothing to do with those lobbyists we were
talking about a second ago. In fact, how dare you accuse lobbyists of doing something that
was in the interest of the industry that it represented. Ugh, there’s always so many
negative Nancys around. Detracting from the hard
work that the lobbyists do, remember, they’re people too. At least on the outside. In the 1960’s, despite
opposition over the idea of a socialized healthcare system, President Lyndon B. Johnson and
other non-racists democrats, you know the ones that
didn’t leave the party over its support for civil rights, all came together and passed Medicaid, which is a government assistance program for low income people, and Medicare, which is a single-payer health program for people over the age of 65. And that sounds good, but then
two other decades happened. – Turning now to the rest
of the agenda for 1974, the time is at hand, this
year, to bring comprehensive, high-quality healthcare within
the reach of every American, and it will not require additional taxes. Other plans have been put forward, and it would put our
whole healthcare system under the heavy hand of
the federal government. This is the wrong approach. this has been tried
abroad and it’s failed. It is not the way we do
things here in America. This kind of plan would
threaten the quality of care provided by our whole healthcare system. – [Narrator] Also that guy put a whole bunch of black people in jail. And then in the 80’s we had
Rapture’s very own Andrew Ryan from Bioshock, but you know,
with like, better music. – My name is Ronald Reagan. I have been asked to
talk on several subjects that have to do with
the problems of the day. One of the traditional methods of imposing statism or
socialism on a people, has been by way of medicine. It’s very easy to
disguise a medical program as a humanitarian project. Most people are a little reluctant to oppose anything that
suggests medical care for people who possibly can’t afford it. James Madison, in 1788 speaking to the Virginia Convention said, “Since the general
civilization of mankind, “I believe there are more instances “of the abridgment of
the freedom of the people “by gradual and silent
encroachment of those in power “than by violent and sudden usurpations.” In this country of ours took place the greatest revolution
that has ever taken place in world’s history, the
only true revolution. A little group of men,
the founding fathers, for the first time, established the idea that you and I had within ourselves the God-given right and ability to determine our own destiny. The right to choose a
doctor, the right to go from one doctor to the other. This is a freedom that I
wonder whether any of us have the right to take
from any human being. One day, as Norman Thomas said, we will awake to find
that we have socialism. You and I must protect
and preserve freedom here or it will not be passed
onto our children, and it will disappear
everywhere in the world. – Total freedom to profit off of your injuries and illnesses. Free to inflate their
prices however they wish. Free to cut corners on their services. Free to say anyone can buy healthcare. Everyone has access to buying healthcare. In the 1990’s the Democrats
advocated pretty hard for health reform, but
despite it being called socialized health by
Republicans, it wasn’t. People still had to
purchase health insurance, it was not single-payer,
though many people to this day try to represent it as such. It was actually a bizarre
and overly bureaucratic approach at quality
assurance and price control over a private industry that
absolutely no one liked. It did not get passed. Something that, unfortunately,
did get passed though was the Medicare
Prescription Drug Improvement and Monetization Act of 2003. The MPDIMA, Muppa Di… Muppa Dima. The Muppa Dima. (chuckling) That is not a catchy acronym. And you know what, I’m
not required to say it, but it was passed by George W. Bush, and was essentially a tool to normalize high deductible health
plans through the creation of health savings accounts. – With this law, we’re
giving older Americans better choices and more control. – An HSA does absolutely nothing
for somebody without money, that means, of course, poor people are automatically at a disadvantage, and as somebody considers
how marginalized groups have to do more in
order to escape poverty, they are at more of a disadvantage. Why? Because a health savings account is just a savings account for health. One, you can’t withdraw
money for other purposes without penalties, so it can’t be used for other emergencies. As a consequence, it is only very useful for people who have money to pay for a high deductible health plan as well as stash away other money for their health savings account. So, not a lot of people, really. I regularly interact with only one person who has money in his savings account, and he lives with his parents, who don’t have money in
their savings accounts. And let’s be quite frank,
that person is a white man. Let’s go the other direction, say you’re a black trans woman, the chances of an HSA helping you, or being something you
rely on are almost nothing, because you are definitely marginalized for obvious identity-oriented reasons on top of likely class-oriented reasons. In other words, money’s
a little bit harder to come by for you and it ain’t
easy to come by for anybody. High deductible health
plans, that is health plans with a high deductible rose to prominence specifically due to the creation
of health savings accounts. Most poor and or marginalized
people can only afford a high deductible health plan because the premiums are lower. However, if they get into an emergency, that deductible is
higher, and they’re liable for a larger amount of money. Essentially, it’s cutting
certain responsibilities out of the insurance companies, namely several thousand dollars usually, and placing that responsibility
on an individual. On top of that, the
industry was crass enough to say it was putting the individual back in control of their health decisions. But that’s a health decision they aren’t even in control of anyhow. Power is control, and in a
for-profit health system, money is power. And if you don’t have money,
you don’t have control over your health decisions. In 2010, the Democrats, led
by President Barack Obama, attempted to reform the healthcare system. Now because part of this little act is selectively withholding information so it can be dramatically revealed later, up until this point I haven’t mentioned that insurance companies used to be able to deny people based on
pre-existing conditions. In other words, if they got sick, called up the insurance company and said, “I’m sick, I need insurance,” they could be like, “No. “Are you crazy? “That’s gonna cost us so much money. “Linda, you gotta hear this. “You gotta come over here. “Listen to what they’ve got “and what they’re asking us to do. “Like, that’s not
something we’re gonna do. (laughing) “Oh no, no, no, no, no, no. “You got cancer or you’re
pregnant, sorry, no.” The major positive that
the Affordable Care Act did was outlaw that bullshit,
because that is… That’s like inhumane, that’s terrible. That’s like dystopian. So that’s over thanks to Obamacare. But being the system is about money, ending that cost money,
and at the same time, people were promised
that they would be able to keep their plans and that
the price of those plans would not go up. In order to make this financially viable with current health costs, they had to mandate that all healthy
people bought insurance. This way people that
didn’t need large amounts of money for their healthcare
were still putting money in and the change in policy
could easily be accounted for. Ah a funny thing about
that mandate though, it didn’t really work. It was very unpopular,
because people didn’t like the idea that they had
to purchase insurance. And to blunt that unpopularity, the mandate was not made to be very high. That is to say, the penalty
wasn’t meaningful enough to force people into insurance. So because there wasn’t an
influx of healthy people, premiums went up instead of down. Some of the more inhumane
aspects of our health system were accounted for, but
ended up costing us more. The mandate just didn’t work, particularly with younger people, who are a total necessity
for funding the system, but as premiums went up, the likelihood of them getting in on it went down. Currently, there are
about 30 million people in this country with no insurance. And while it is in many ways
better than what came before, it is also in ways worse. Certainly, there are people thanks to the Medicaid expansions that never could have afforded
life-saving procedures, medicine, and in-home equipment, and for that reason,
it’s massively important that this was passed. Still, it clearly isn’t the solution. It doesn’t pay for itself. You lose. You get nothing. Good day, sir. Since the Affordable Care Act was passed, the Republicans have claimed
that they have a solution. At every opportunity, they said it needed to be repealed and replaced. So what was the idea they proposed in 2017 when they finally had power? Well first, they repealed
the mandate, kinda. Instead of a tax penalty
for not carrying insurance, providers would have
to add a 30% surcharge to people who have not had insurance for the last 63 days that
would last for 12 months. After that, the 30% would go away and you would pay the
quote-unquote normal rate. Now here’s why that doesn’t work. If you stayed uninsured
for roughly four months, you would’ve saved up the extra amount that you would pay that following year. Meaning, under the
American Health Care Act, the Republican plan, if
you managed to stay off of insurance for more than four months, congratulations, you beat the system, Neo. Red pill. But like a real red pill. Like a health red pill. Not like a mana sphere thing. Like a real pharmaceutical red pill. Also like a Matrix thing. Yeah. So it basically has the same problem that the ACA has, except worse in that it can’t pay
for itself in any way. It also limited and then eliminated the Medicare expansion that
was in the Affordable Care Act, the Congressional Budget Office, an independent commission,
estimated that it would kick 24 million people off of health care, which by the way would
put the uninsured total at higher than before
the Affordable Care Act. That’s right, repealing
the Affordable Care Act with nothing to replace it would have been less damaging than replacing it with the American Health Care Act. Nobody liked it. Everybody was mad. Republicans, Democrats, Independents, third parties, didn’t
matter, everyone was mad. Everyone called their representatives. Everyone called their senators. They made these people show
up at town hall meetings where they screamed at
them, “What are you doing?” And these elected officials did resist. They really didn’t want to
meet with their constituency face-to-face to see exactly
how angry they were. Voters, the people who put
them into their office, hated this healthcare bill,
yet they passed it anyway, including one of the representatives from my own state of Michigan who, for literally months, said that he wasn’t going to vote for it. In fact, he made one of
the last minute deals with the deal-maker in chief, $3 trillion is spent on healthcare
annually in the United States, and in order to cover his ass, he got eight billion allocated over the course of five years for people with pre-existing conditions, which again, $8 billion over five years in
a $3 trillion a year industry is jack shit. People were pissed at this guy too. His main office is in the city I live in, St. Joseph, Michigan, and
to show their displeasure, residents left flip-flops
on his office’s doorstep. Just a couple days after the vote, the annual Blossom Time Parade
went down in the same city. Usually, Representative Upton rides a car through this parade, waving
at all of his adoring public. He didn’t show up this year, wonder why. Anyway, the AHCA passed the
House of Representatives. Now what did the Republican plan tell us? Well, it showed us that
neither the Republicans or the Democrats have been able to create a healthcare plan that
prioritizes quality care for everyone, delivers
satisfactory profits to the corporations that administer them, and pays for itself, or have they? You see, if we go back
all the way to 1965, we already have a
single-payer health system in the United States of America, it’s just for people who are 65 and up. But what is single-payer? Why is it something that is good as opposed to everything
else in the world right now? According to Amnesty International, an organization that exposes and prevents human rights abuses, healthcare is a human right. Healthcare is a public good,
and it is not a commodity. Single-payer is a publicly-administered national health insurance. Under a single-payer system, all residents of the United States would be covered for all medically-necessary services, including doctor visits, hospitals, preventative care, long-term care, mental health, reproductive health, dental, vision, prescription
drug, and medical supply costs. But it’s not just about health. Single-payer healthcare would be a universalizer of experience. Think about it, we’ve
talked so much lately about how the fabric of reality
itself has become fragile. And I’ve put forward a lot of material that says the individualization of reality is mostly responsible,
well think about religion. Religion has stopped
being a collectivizer. One in 10 people in America
are atheists, myself included. And many who believe in God
have individualized their faith. They have picked and
choosed, which is fine. I don’t want people to stone women for thinking like in the Old Testament. But although the facts
that religion’s put forward are not, well, my favorite
things in the world, they were a unified fact set. They were a collective reality. The uniting experience of religion is something that people look to even now. A church can provide this,
but it’s not universal. I think healthcare is part
of the cure for that too. In a single-payer system,
everyone’s welcome. Everyone needs it. And it’s more than just delivering on the human right to healthcare, it’s an experience that we all have. A collectivizer, a set of facts that becomes universal
when everyone is allowed in and allowed the same
expectations, outcomes, and consequences, and people
need that more than you think. Collectivizing around healthcare is a science-based unification of fact. It’s maybe better than one that’s rooted in stoning women and hitting
gay people and stuff. I mean… And I’m not saying all
religious people hate gay folks, nor am I saying that this
is just free healthcare. It’s a system we all pay
into based on our incomes and all have an equal right to. It’d be part of our lives we dedicate to philanthropy automatically. Compared to a casual
involvement in religion, single-payer has more material effect with no effort outside your normal day. It might not be heroism, per se, but it is being a part of something that would help tens of
millions immediately. I would say that’s pretty good. And do you want to opt
into a collective reality with a universal set of facts, or maybe you’re just good, a good person? Single-payer isn’t just
the right direction for our country, it’s the right
direction for our reality. There are 32 developed
nations in the world, 31 of which have universal healthcare. There is one that doesn’t,
the United States of America. Who’da thunk? (laughing) Now, there are variations on it like completely nationalized healthcare like in the United Kingdom. And there’s systems like France’s, where most things are
publicly-administered while a few things aren’t. But if you live a developed nation other than the United States of America, you’re most likely never handed a bill for services rendered. And if you are, it’s probably minuscule. For instance, in France
a costly medical bill is considered $200 and a lot of the time it ends up being reimbursed. You know, by the government. Or in countries like
Italy, Norway, Sweden, Canada, the United Kingdom, Spain, Japan, and many others, a
single-payer health system wouldn’t just insure
that everyone has access to healthcare, but that
the healthcare is paid for. If access is the only concern, then requiring providers to see patients is really all that’s necessary. But have you ever seen an emergency room that isn’t just plain full of people? People use the emergency room because they’re required to be seen there. It doesn’t matter if they have money or insurance, it matters
that they have a problem. And while their lives may be saved or they may get whatever
treatment that they need, they now have another problem, money. People stay away from medical
care because it costs money, and that’s whether you do
or don’t have insurance. If you do, and don’t have the money for a plan with a very
large monthly premium, that is payment, it’s very likely a high deductible health
plan with a monthly premium that’s still going up every year. And a deductible that’s so
high, it’s nearly meaningless. To someone without any money, $4500 might as well be $45,000. Besides giving people healthcare without running the risk
of bankrupting them, having one nationalized health insurance would mean having one set of rules, meaning rules protecting
marginalized groups and the specific types of
care they might require, you know, reproductive rights
and trans health rights among other things, would not
be subject to states’ rights. Let’s not forget that
the term states’ rights came from the Civil War and was used by states in the Confederacy
who wanted to maintain slaves. If you’ve ever heard the term dog whistle, a subtly aimed political message which is intended for and
can only be understood by a particular group, usually people who hold negative views
of marginalized people, instead of states’ rights
in which certain states are allowed to discriminate
against certain groups. States would have a set of
rules that they had to follow, and that’s that. Even if that set of rules
wasn’t perfect at the start, it would still be one set of
rules to petition for change. And considering everybody has to pay taxes when they make money one way or the other, I would much rather have a health system that at least has the capacity to eventually serve everyone properly. What we have right now
absolutely does not. A lot of people often
worry that single-payer would be allowing politicians
to run the health system, but luckily Medicare is run
by its own administration, specifically the CMS, the Centers for Medicare
and Medicaid Services. It’s also right now the
largest health insurance administration organization
in the entire country. If Medicare was open to all people, that wouldn’t change except it would need significantly more employees after taking on everyone under 65. If you’re worried about the jobs of people who currently administer health
plans for private companies, well guess what, they are
the most qualified people for those jobs. Our entire lives, we’ve been told that the marketization of healthcare gives us the power to
make our health decisions and gives us access to the best doctors, the ones we want to visit. But that’s just not true. Those decisions are
made behind closed doors by boards of executives and shareholders without any transparency or public record. Here’s the thing about
all products and services, the product or the service
is a means to attain profit. That means in the healthcare industry, health is always a means to attain profit. This gives incentive to
insure healthy people, and deny unhealthy people,
which creates a system that is flat-out not fair. Around 30 million people currently have no insurance, and significantly
more are under-insured. The risk of bankruptcy
for both of those groups, particularly the ones without insurance, is just a little bit uncomfortable high. People get sick, it’s a fact of life. The fact that we put older people onto a single-payer system, people who are more
vulnerable to health problems, should say something specifically about the priority of
a single-payer system. Is it possible to attain
universal healthcare in a market situation? No. Markets are purported to be built around the idea of competition. And no matter what anybody says, competition fragments the market. Many aspects of our
current healthcare system are entirely proprietary. That is to say, are only employed by one insurance company,
because they developed it for their own internal usage. Billing, negotiation, networks, interacting with different
providers, it’s not consistent. Advocates for the private
system like Ted Cruz, whom everybody loves, like to
say the country’s just too big for a system like the one that works in the smaller European countries. It’s competition that keeps prices low, and eventually a competitive market will bring universal coverage. But the fact is the market is never going to provide anything
quote-unquote universal, ever. The whole point of a
market is that there are multiple things competing. It’s completely inherent. If it derives price controls from a competitive market
situation, it’s not universal. Competition and universal are
words that are incompatible. If anything, the fact that
this country is so large provides an argument
for the standardization of the healthcare system and
not the further fragmentation. The market does not provide this. The more privatized it
is, the further away from universal it is. Neither Republicans or Democrats can pretend that they’ve ever fought for anything under the vague umbrella term of universal, they haven’t,
not in any serious capacity in the last 40 years anyhow. Insurance companies don’t support it, but 60% of US physicians do. And there’s a fair amount
of them that aren’t sure, because only 32% of doctors oppose it. Only 36% of voters oppose it. Only 30% Democrats. Only 33 of Independents oppose it. And only 47% of Republicans
oppose single-payer healthcare. 35% of Republicans support it. And 18% of them just need more info. Can we afford universal coverage? Uh, yes, ’cause we’re paying more than it would actually cost if we did it. As in right now, we are paying more if you combined what we spend privately and what we pay in taxes for subsidies and also into the
Medicare plan that covers only people 65 and up and not to mention about 31% of our private spending goes specifically to administration because there’s so many middle men in-between you and healthcare, not to mention that every single one of these companies has a
massive marketing budget. Where do you think that money comes from? And do you think that’d be even necessary in a system where everybody just, you know, didn’t waste a ton
of money on that kinda crap? What about medical research? Wouldn’t a publicly-financed
system kinda stifle that? Well, most breakthroughs are
already publicly-financed. According to the National
Institutes of Health, out of the last 30 Americans to win the Nobel Prize in Medicine,
28 were directly funded by the National Institutes of Health. Also, let’s not forget that Toronto, you know, Toronto, Ontario, Canada, is home to numerous high-tech, well-funded research facilities, including the University of Toronto’s Department of Medical Biophysics, where several recent cancer treatment
breakthroughs have been made, but all of these statistics can be met with counterpoints that Ted Cruz can pull out of his binder that he
brought to look official. Unfortunately, we’re living in a time where facts have been
highly individualized, and if the information
that’s dictated to people is not correct information,
it’s pretty hard to disprove it. Statistics sound like statistics whether they’re right or wrong, whether they come out of my
mouth or the mouth of Ted Cruz. Although I don’t even have a vague idea how to sound nearly as
smarmy as Ted Cruz does, so there’s that. And instead of continuing
to rattle off information, bullet points, highlights,
sound bites, et cetera, I wanna talk to you about
pattern recognition. There are 32 developed
nations in the world. 31 one of them have universal
healthcare coverage. Almost all of those
countries do it entirely through taxpayer funding,
and when they don’t, they typically do it partially that way. That’s a pattern. It works. Pattern recognition is an
innate ability of human beings. We’re supposedly better at it than every single other species out there. So why have we been ignoring
this one for so long? Is it because our system
is really that good? Hold your breath. Make a wish. ♫ Come with me and you’ll be ♫ In the only one of all developed nations ♫ Just get sick and you’ll
need to arrange payment ♫ Cancer and being trans and maybe ♫ Even getting an abortion ♫ Pregnancy is a pre-existing condition ♫ If you want to feel marginalized ♫ Got religious freedom on standby ♫ Anything they want to deny ♫ With the AHCA it’s easy as pie ♫ This is America claim-free
health is radicalization ♫ Living here you’re healthy ♫ But only if you pay (crashing) Shit. (funky hip-hop music)