[Music]
good afternoon my name is Tom vote and I
would like to draw your attention before
we get into this to the two quotes on
this screen the first from the premier
editor of the nation’s leading
scientific journal calling our health
system a more embarrassing disaster each
year the second from the White House
proposing new initiatives for the
world’s best health care system I want
you to ponder that contradiction as we
go through this I first got interested
in health care issues as a Peace Corps
volunteer after college in Eritrea and
Ethiopia as a part of that experience I
was invited to go on a smallpox
vaccinating expedition to northwestern
Eritrea where we vaccinated desert
nomads that’s me doing my very first
medical procedure that I ever did in my
life the interesting thing is that
smallpox vaccination was invented in the
1790s by Jenner it took almost two
hundred years for us to learn how to use
that vaccine effectively so that we
could eliminate smallpox from the world
and we did so 12 years after that
picture was taken the World Health
Organization announced smallpox was a
thing of the past we need to learn that
listen for our healthcare system so
let’s get into that the United States is
the only developed nation on the planet
that does not have universal health care
we rank last among those nations in life
expectancy last in infant mortality last
in patient satisfaction and we spend
twice as much as any other nation on
health care or approximate on average
twice as much but more than any other
nation the irony is that we have the
world’s finest medical
CAIR technology and yes you can get
wonderful care in this country but good
luck accessing it after 30 years of
debate why are the majority of Americans
not aware of those easily verifiable
statistics we’ll get into that it raises
three important questions what are other
nations doing that we are not doing what
are we doing that they aren’t doing and
if we learn from other nations that have
successfully reformed health care
systems what can we accomplish that’s
what we’re talking about today so first
of all what’s wrong with US health care
I love this metaphorical slide it pretty
much gets one of the problems straight I
was going down Wilshire Boulevard in Los
Angeles at rush hour as a passenger
fortunately so I could take the picture
and there were two road crews one
pointed what planted one of those signs
one planted the other one they had no
communication and the whole street was
totally frozen for a couple of hours so
that tells you one of the problems and I
don’t have to explain that one anymore
in 1960 ignore the little boxes on this
graph up there because they’re not
relevant to what I’m talking about here
in 1960 the left side of that screen we
spent 5% of our healthcare budget 5% of
our GDP gross domestic product on health
care and we ranked higher in the world
than we do now in terms of all of those
statistics I gave you before in 1917 we
spend seventeen and a half percent of
our GDP and our own government and
that’s far more than any other country
our own government forecasts that by
2025 our health care costs will increase
another 73 percent and by 2045 our
health care costs unless we do something
drastic will exceed our entire gross
domestic product which of course is
impossible but economic collapse isn’t
so what is wrong why is our system so
costly and so inefficient there are a
lot of reasons for it I’ve picked out
what I think are the five most important
ones they’re not the only ones but these
are the biggies
no other country in the world has more
than ten entities paying the bills for
health care
the US has over a thousand payers
including governments industries
agencies private insurance companies and
so on and over 3,000 health plans it has
been calculated that if we simply did
nothing else but copied the single-payer
system of Canada that it would save 300
billion dollars a year because of the
legal and administrative morass of
arguments over who’s responsible for
what in our company company as you’ll
see I’m not I don’t think a single-payer
system is essential because there are
countries that have a few payers and
they do just as well but a thousand
three thousand health plans doesn’t work
secondly we have a lot of ridiculous
stupid laws passed by Congress and
lobbyists who help them get elected and
stay elected the US government is the
only entity on the planet that isn’t not
allowed by law to negotiate drug prices
when they buy drugs from companies that
make them in New Jersey when New Jersey
sells those country those drugs to
Russia or China or socialist countries
communist countries that we think of as
having closed economies they negotiate
prices and they end up paying about
one-fourth to one-fifth of what we pay
in this country because they’re not
allowed to negotiate the US government
is also one of only two nations in the
world that allows prescription drug
advertising to patients and are not to
dock to doctors a letter a lot of people
could advertise but not to patients that
cost five billion dollars in 2015 which
is also added to our drug prices and to
top that off they said oh you can’t
cross the border and bring drugs in from
elsewhere that’s also illegal
we have great health research but we
don’t pay any attention to our very
little attention to cost and to
mechanisms of delivery we have no free
market in this bastion of capitalism
it’s against the law for hospitals to
tell you what they charge and a little
clandestine survey done a couple done a
couple years ago in California showed
that a simple uncomplicated cesarean
section across several dozen hospitals
range in price from five thousand to
eighty eight thousand dollars and you
can’t find that out it’s like you go
into the mall and you want a TV set you
think it’s gonna cost eight hundred
dollars and you say how about just that
TV set and the clerk says I don’t know
but you just take it home most ninja
bill so you’ve taken home and two weeks
later you’re gonna bill for $16,000 as
ridiculous as that sounds
it’s exactly how our system works we
have no shared risk the fact as you’ll
see the the numbers in a minute every
country not only has in developed
country not only has universal health
care they pay less and have better
outcomes and finally why don’t our
lawmakers address these problems and the
answer is clear they don’t address them
because it costs so much to run an
election only the major corporate donors
have enough money to get them reelected
and if they address this they will not
get reelected and there are some actual
examples of that so what’s happening
next for US healthcare we’re at a fork
in our road this is one of the forks and
that’s where it goes will drown
economically and health-wise as well if
we keep doing what we’ve been doing for
thirty years that is arguing and
bickering about how to change our
healthcare system without actually
addressing the real problems that make
it so effective inefficient and
expensive costs escalate the economic
collapse is likely maybe even inevitable
fewer people have insurance because the
great American Way is oh gee when it
gets expensive we’ll just throw people
out of the system no other country
denies everybody health care and they do
it cheaper medical bankruptcies will
increase we are already the only country
on the planet where medical bankruptcy
is the leading cause of
crup see and social justice this
satisfaction is gonna get a lot worse
what can we learn from other nations
these are the essential things that you
should expect a rational educated
politician debating healthcare reform to
address reduce the number of insurers
dramatically restore a free market
negotiate prices public release of
prices compete on cost instead of on how
many big machines and high-end
specialists you have ban prescription
drug advertising universal coverage
saves money it does every other
developed nation has it for less and
better outcomes fund and publicize cost
effectiveness research your advertising
to you convinces you with those gorgeous
ads on television and smiling people
that you should buy a drug that cost 50
to 60 times as much as a generic drug
that nobody advertises anymore
that may be at least as effective and
sometimes even more effective but we
don’t find out about that legislative
collaboration cooperation and compromise
are essential politics is the art of
compromise and if there is none you have
a dysfunctional government as well I
made this table from a CIA World
Factbook table in online table and I
calculated the green bars they didn’t
have those numbers but they gave all the
numbers you needed to calculate them
this ranks 19 developed countries Japan
through the u.s. in order of life
expectancy Japan lives four and a half
years longer than the average American
and all of those countries have
universal health care except us
and they all cost less the bars are the
amount of money we would save in this
country per person per year if we
actually adopted entirely the health
system of those countries the average of
all of them is if was about five
thousand dollars a year that’s pretty
dramatic if we did that depending on
which of those countries we copied we
would save between one and
two point four trillion dollars a year
that’s three thousand two hundred and
fifty dollars a trillion dollars is
three thousand twenty dollars for every
single person in the country we could
increase life expectancy improve
satisfaction and ensure everyone because
all those other countries already have
those things on that and we could use
the extra money to repair our
infrastructure balance the federal
budget reduce college tuitions address
global warming or lots of other things
we have a problem though you could not
simply reach in the pot and pick a
trillion dollars out of the health care
industry and throw it somewhere else
without causing financial medical and
political chaos so you have a model to
help you figure out how to do it in the
1980’s Taiwan had a very similar health
system to our own it was a dysfunctional
cost soaring and they acted with some
intelligence the appointed team of
experts to tour the world for several
years looking at what works around the
world in health system from that they
created a new system and then they took
another four or five years to implement
it gradually a little bit at a time did
it work
within five years after their
implementation they fell from 50th in
the world and life expects an expectancy
to 15th their patient satisfaction went
from 25% to 85% and their costs fell
dramatically it’s not like we don’t know
how to do it it’s that we don’t have the
will to do it part of it is that we
haven’t talked about the underlying
cause in 1976 the Supreme Court decreed
that money is free speech and that those
with the most money can determine who
wins elections since that time the cost
of getting elected to any political
office has soared about 10 fold the only
way you can get that kind of
money is from big donors and these are
the big donors the two biggest donor
industries are healthcare and defense
that’s where the money comes from and
that’s where you just wrote here honest
pronouncements from our politicians this
is not a Republican or Democrat issue it
is nonpartisan it’s true for both
parties 60 nations I talked you about
the developed nations but there are
actually about 25 non developed nations
that have universal health care and do
better a soft landing with this problem
of our health care system is possible if
we do it right those are the countries
that already have universal health care
let me say a word about what I mean by
universal health care that means
everybody has some basic health care
available to them no exceptions no
exclusions for pre-existing conditions
that’s true in all of these countries
the amount of benefit varies almost all
countries have a mix of basic government
paid universal health systems and an
option to buy additional coverage from
what are often called insurer insurance
exchanges rather than companies with
very clear benefits and prices that are
upfront and straightforward and they
choose which they want we don’t have
that it’s if you hear a politician say
the u.s. the nations are the world’s
richest economy cannot afford universal
health care that person is either
woefully misinformed or he or she is
deliberately misleading you we have a
serious problem our health care industry
is threatening our economy I talked
about that small pox way back then 200
years it took to figure out how to use
small vaccine to get rid of smallpox we
don’t have to wait two hundred years for
health care to
how to deliver it effectively because we
got all these other countries that are
already doing it I’m not saying they
don’t have problems but they are had
better outcomes and less expense by
volumes than we have it’s time for us to
figure out what we’re doing wrong and
fix it what can you do
I say it’s tuffnut but you have to think
about this I don’t care what party
you’re from if a politician you can vote
for is running for office and mentions
health care and doesn’t talk about those
five basic problems that we went into
don’t vote for him and tell everybody
why you’re not vote for him
tell your politician why you’re not
voting for him if you will recall John
McCain ran on the platform in 2000 for
president on the platform of Alpha the
biggest problem in this country is that
1976 buckley versus vallejo supreme
court decision and we have to change it
he never mentioned it after he lost that
election in nineteen 2008 he was
interviewed by a reporter who asked him
why he hadn’t mentioned it again
and his response was there are more
important problems now I’m not I can’t
pretend to know what was going on in his
mind but it makes me wonder we have to
act about this as if our lives and our
economy depend on it because they do
[Applause]
good afternoon my name is Tom vote and I
would like to draw your attention before
we get into this to the two quotes on
this screen the first from the premier
editor of the nation’s leading
scientific journal calling our health
system a more embarrassing disaster each
year the second from the White House
proposing new initiatives for the
world’s best health care system I want
you to ponder that contradiction as we
go through this I first got interested
in health care issues as a Peace Corps
volunteer after college in Eritrea and
Ethiopia as a part of that experience I
was invited to go on a smallpox
vaccinating expedition to northwestern
Eritrea where we vaccinated desert
nomads that’s me doing my very first
medical procedure that I ever did in my
life the interesting thing is that
smallpox vaccination was invented in the
1790s by Jenner it took almost two
hundred years for us to learn how to use
that vaccine effectively so that we
could eliminate smallpox from the world
and we did so 12 years after that
picture was taken the World Health
Organization announced smallpox was a
thing of the past we need to learn that
listen for our healthcare system so
let’s get into that the United States is
the only developed nation on the planet
that does not have universal health care
we rank last among those nations in life
expectancy last in infant mortality last
in patient satisfaction and we spend
twice as much as any other nation on
health care or approximate on average
twice as much but more than any other
nation the irony is that we have the
world’s finest medical
CAIR technology and yes you can get
wonderful care in this country but good
luck accessing it after 30 years of
debate why are the majority of Americans
not aware of those easily verifiable
statistics we’ll get into that it raises
three important questions what are other
nations doing that we are not doing what
are we doing that they aren’t doing and
if we learn from other nations that have
successfully reformed health care
systems what can we accomplish that’s
what we’re talking about today so first
of all what’s wrong with US health care
I love this metaphorical slide it pretty
much gets one of the problems straight I
was going down Wilshire Boulevard in Los
Angeles at rush hour as a passenger
fortunately so I could take the picture
and there were two road crews one
pointed what planted one of those signs
one planted the other one they had no
communication and the whole street was
totally frozen for a couple of hours so
that tells you one of the problems and I
don’t have to explain that one anymore
in 1960 ignore the little boxes on this
graph up there because they’re not
relevant to what I’m talking about here
in 1960 the left side of that screen we
spent 5% of our healthcare budget 5% of
our GDP gross domestic product on health
care and we ranked higher in the world
than we do now in terms of all of those
statistics I gave you before in 1917 we
spend seventeen and a half percent of
our GDP and our own government and
that’s far more than any other country
our own government forecasts that by
2025 our health care costs will increase
another 73 percent and by 2045 our
health care costs unless we do something
drastic will exceed our entire gross
domestic product which of course is
impossible but economic collapse isn’t
so what is wrong why is our system so
costly and so inefficient there are a
lot of reasons for it I’ve picked out
what I think are the five most important
ones they’re not the only ones but these
are the biggies
no other country in the world has more
than ten entities paying the bills for
health care
the US has over a thousand payers
including governments industries
agencies private insurance companies and
so on and over 3,000 health plans it has
been calculated that if we simply did
nothing else but copied the single-payer
system of Canada that it would save 300
billion dollars a year because of the
legal and administrative morass of
arguments over who’s responsible for
what in our company company as you’ll
see I’m not I don’t think a single-payer
system is essential because there are
countries that have a few payers and
they do just as well but a thousand
three thousand health plans doesn’t work
secondly we have a lot of ridiculous
stupid laws passed by Congress and
lobbyists who help them get elected and
stay elected the US government is the
only entity on the planet that isn’t not
allowed by law to negotiate drug prices
when they buy drugs from companies that
make them in New Jersey when New Jersey
sells those country those drugs to
Russia or China or socialist countries
communist countries that we think of as
having closed economies they negotiate
prices and they end up paying about
one-fourth to one-fifth of what we pay
in this country because they’re not
allowed to negotiate the US government
is also one of only two nations in the
world that allows prescription drug
advertising to patients and are not to
dock to doctors a letter a lot of people
could advertise but not to patients that
cost five billion dollars in 2015 which
is also added to our drug prices and to
top that off they said oh you can’t
cross the border and bring drugs in from
elsewhere that’s also illegal
we have great health research but we
don’t pay any attention to our very
little attention to cost and to
mechanisms of delivery we have no free
market in this bastion of capitalism
it’s against the law for hospitals to
tell you what they charge and a little
clandestine survey done a couple done a
couple years ago in California showed
that a simple uncomplicated cesarean
section across several dozen hospitals
range in price from five thousand to
eighty eight thousand dollars and you
can’t find that out it’s like you go
into the mall and you want a TV set you
think it’s gonna cost eight hundred
dollars and you say how about just that
TV set and the clerk says I don’t know
but you just take it home most ninja
bill so you’ve taken home and two weeks
later you’re gonna bill for $16,000 as
ridiculous as that sounds
it’s exactly how our system works we
have no shared risk the fact as you’ll
see the the numbers in a minute every
country not only has in developed
country not only has universal health
care they pay less and have better
outcomes and finally why don’t our
lawmakers address these problems and the
answer is clear they don’t address them
because it costs so much to run an
election only the major corporate donors
have enough money to get them reelected
and if they address this they will not
get reelected and there are some actual
examples of that so what’s happening
next for US healthcare we’re at a fork
in our road this is one of the forks and
that’s where it goes will drown
economically and health-wise as well if
we keep doing what we’ve been doing for
thirty years that is arguing and
bickering about how to change our
healthcare system without actually
addressing the real problems that make
it so effective inefficient and
expensive costs escalate the economic
collapse is likely maybe even inevitable
fewer people have insurance because the
great American Way is oh gee when it
gets expensive we’ll just throw people
out of the system no other country
denies everybody health care and they do
it cheaper medical bankruptcies will
increase we are already the only country
on the planet where medical bankruptcy
is the leading cause of
crup see and social justice this
satisfaction is gonna get a lot worse
what can we learn from other nations
these are the essential things that you
should expect a rational educated
politician debating healthcare reform to
address reduce the number of insurers
dramatically restore a free market
negotiate prices public release of
prices compete on cost instead of on how
many big machines and high-end
specialists you have ban prescription
drug advertising universal coverage
saves money it does every other
developed nation has it for less and
better outcomes fund and publicize cost
effectiveness research your advertising
to you convinces you with those gorgeous
ads on television and smiling people
that you should buy a drug that cost 50
to 60 times as much as a generic drug
that nobody advertises anymore
that may be at least as effective and
sometimes even more effective but we
don’t find out about that legislative
collaboration cooperation and compromise
are essential politics is the art of
compromise and if there is none you have
a dysfunctional government as well I
made this table from a CIA World
Factbook table in online table and I
calculated the green bars they didn’t
have those numbers but they gave all the
numbers you needed to calculate them
this ranks 19 developed countries Japan
through the u.s. in order of life
expectancy Japan lives four and a half
years longer than the average American
and all of those countries have
universal health care except us
and they all cost less the bars are the
amount of money we would save in this
country per person per year if we
actually adopted entirely the health
system of those countries the average of
all of them is if was about five
thousand dollars a year that’s pretty
dramatic if we did that depending on
which of those countries we copied we
would save between one and
two point four trillion dollars a year
that’s three thousand two hundred and
fifty dollars a trillion dollars is
three thousand twenty dollars for every
single person in the country we could
increase life expectancy improve
satisfaction and ensure everyone because
all those other countries already have
those things on that and we could use
the extra money to repair our
infrastructure balance the federal
budget reduce college tuitions address
global warming or lots of other things
we have a problem though you could not
simply reach in the pot and pick a
trillion dollars out of the health care
industry and throw it somewhere else
without causing financial medical and
political chaos so you have a model to
help you figure out how to do it in the
1980’s Taiwan had a very similar health
system to our own it was a dysfunctional
cost soaring and they acted with some
intelligence the appointed team of
experts to tour the world for several
years looking at what works around the
world in health system from that they
created a new system and then they took
another four or five years to implement
it gradually a little bit at a time did
it work
within five years after their
implementation they fell from 50th in
the world and life expects an expectancy
to 15th their patient satisfaction went
from 25% to 85% and their costs fell
dramatically it’s not like we don’t know
how to do it it’s that we don’t have the
will to do it part of it is that we
haven’t talked about the underlying
cause in 1976 the Supreme Court decreed
that money is free speech and that those
with the most money can determine who
wins elections since that time the cost
of getting elected to any political
office has soared about 10 fold the only
way you can get that kind of
money is from big donors and these are
the big donors the two biggest donor
industries are healthcare and defense
that’s where the money comes from and
that’s where you just wrote here honest
pronouncements from our politicians this
is not a Republican or Democrat issue it
is nonpartisan it’s true for both
parties 60 nations I talked you about
the developed nations but there are
actually about 25 non developed nations
that have universal health care and do
better a soft landing with this problem
of our health care system is possible if
we do it right those are the countries
that already have universal health care
let me say a word about what I mean by
universal health care that means
everybody has some basic health care
available to them no exceptions no
exclusions for pre-existing conditions
that’s true in all of these countries
the amount of benefit varies almost all
countries have a mix of basic government
paid universal health systems and an
option to buy additional coverage from
what are often called insurer insurance
exchanges rather than companies with
very clear benefits and prices that are
upfront and straightforward and they
choose which they want we don’t have
that it’s if you hear a politician say
the u.s. the nations are the world’s
richest economy cannot afford universal
health care that person is either
woefully misinformed or he or she is
deliberately misleading you we have a
serious problem our health care industry
is threatening our economy I talked
about that small pox way back then 200
years it took to figure out how to use
small vaccine to get rid of smallpox we
don’t have to wait two hundred years for
health care to
how to deliver it effectively because we
got all these other countries that are
already doing it I’m not saying they
don’t have problems but they are had
better outcomes and less expense by
volumes than we have it’s time for us to
figure out what we’re doing wrong and
fix it what can you do
I say it’s tuffnut but you have to think
about this I don’t care what party
you’re from if a politician you can vote
for is running for office and mentions
health care and doesn’t talk about those
five basic problems that we went into
don’t vote for him and tell everybody
why you’re not vote for him
tell your politician why you’re not
voting for him if you will recall John
McCain ran on the platform in 2000 for
president on the platform of Alpha the
biggest problem in this country is that
1976 buckley versus vallejo supreme
court decision and we have to change it
he never mentioned it after he lost that
election in nineteen 2008 he was
interviewed by a reporter who asked him
why he hadn’t mentioned it again
and his response was there are more
important problems now I’m not I can’t
pretend to know what was going on in his
mind but it makes me wonder we have to
act about this as if our lives and our
economy depend on it because they do
[Applause]
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