Health care is one of the most debated issues among Democratic presidential candidates. While candidates including Sen. Bernie Sanders (D-VT) and Sen. Elizabeth Warren (D-MA) have ambitions to eliminate private insurance, Joe Biden wishes to build upon Obamacare and allow Americans to choose whether they have private insurance.
Dr. Scott Atlas of the Hoover Institution shares his perspective on health care reform with Guy Benson.
Guy Benson [00:00:00] It is the final hour of the week on this show, it's the happy hour. I'm Guy Benson from Palo Alto, California. The campus of Stanford University and specifically the Hoover Institution celebrating 100 years which is remarkable. I am thrilled to be here and we'll be back here in the fall as we've been telling you for a full week, which I'm very excited about. And when we come back I'm sure we will have much to discuss again with my next guest who joins me here in studio at Hoover, Dr. Scott Atlas he's a medical doctor. He is the David and Joan trade tell senior fellow at the Hoover Institution and his area of expertise is health care policy and particularly single payer health care which is a topic he and I have discussed previously in visits here that I've made in the past. It feels more immediately relevant today because now one of the two major parties in this country political parties has shifted very dramatically openly in favor of single payer health care. Doctor great to see you again.
Dr. Scott Atlas [00:01:08] Great to see you too, Guy.
Guy Benson [00:01:09] You've had a few pieces in the last week or so. One in The Wall Street Journal, one of the Washington Times talking about the broader issue of single payer health care. I want to start with. The subject or the thrust of your Wall Street Journal piece and we had Lanhee Chen on the show yesterday and we got into this a little bit but I want you to really break this down for people because I saw earlier today Joe Biden his campaign they're running an ad it's a smart ad in the Democratic primary featuring a union worker who has private insurance who likes her insurance and she is saying I would not want single payer health care because it would take away my insurance. And the argument the Biden campaign has been making is Kamala and Bernie and Warren their plan would eliminate people's private insurance whereas Biden wants to build on Obamacare keep Obamacare. But with the caveat this is his so-called moderate policy right, the compromise is how they're framing it a buy in option to Medicare for all. So it's kind of referred to in wonk terms as the public option. If you could just explain how that would work and why it's actually fundamentally kind of dishonest because it will bring us to single payer.
Dr. Scott Atlas [00:02:23] Yes. Well this is very important for people to understand. I'll start with the bottom line. A public option is not a compromise moderate position. The inevitable consequence of a public option for health insurance is private insurance will disappear for everyone except the affluent because they're the only people who will be able to afford that insurance. So the only people stuck with single payer nationalized insurance will be the poor and the middle class the very people who the Democratic Party claims to be their interests in terms of this inequality issue. They will have unequal access and unequal quality of health care. Now the reason why the public option leads to single payer health care for everyone except you know perhaps the few who can afford private care.
Guy Benson [00:03:21] I want people to really listen to this. This is very important because you're going to hear especially if Biden becomes the nominee and not one of the people who's out there loud and proud for a full blown single payer you're going to hear that this is the moderate compromise. And Dr. Scott Atlas. Go ahead explain why it in fact is not.
Dr. Scott Atlas [00:03:40] Yes. Well the first thing that's true about a introducing an option. Under the guise of hey who wouldn't want more choice isn't that Republicans always talk about this public option that ultimately ends up eroding those and crowding out those with private insurance and crowding out. This is a sort of an economics term crowd out of people with private insurance. How does it do that. Because it it is going to falsely artificially be cheaper than private insurance. And so everyone shifts into it. How. First of all what's the basis for me saying that that will happen. Well it's already been happened. It's data it's proven. It's not an assertion like many things you'll hear in the in the health health care debate. We know that in Hawaii this was tried and seven months four children and seven months after that program was introduced as an option more than 80 85 percent of people who took up the program had private insurance. They weren't uninsured which was the intent the stated goal. People shifted from private insurance over there. Now you'd say well but to to the government of the government option. And so it it it ends up that it just puts people who were previously paying for private insurance out of their pocket onto the public taxpayer dollar from everybody else. So then you might say well why isn't that OK. They chose the public option must be appealing. So must be appealing. Well the reason is they take it because it's cheaper. OK. And now why is it cheaper? It's cheaper because of two reasons.
Guy Benson [00:05:22] The government makes it cheaper.
Dr. Scott Atlas [00:05:24] Two critical reasons here that affect your health outcomes which of course the purpose of health care reform is to broaden access to good health care so that you have better health. It's not that complicated but nobody talks about that. But the reality is it's cheaper for two reasons. Number one we know from our own Medicare and Medicaid. They simply pay less than private insurance to doctors and hospitals. Now that that isn't so bad. On the top on a first perusal of that. But what do you mean pay less. They don't just pay less than private insurance the so-called reimbursement rate. Right. They pay less than the cost of delivering the care.
Guy Benson [00:06:10] So this is they're taking a loss. The providers are taking a loss.
Dr. Scott Atlas [00:06:13] Doctors and hospitals, health care providers are getting paid less than it costs them to deliver the care. And the old joke while you lose money per perv widget but you make up for it in volume. Of course it's it's nonsensical. You go out of business and so to prevent going out of business you stop offering that care. That's point number one point number two single payer. That's factual. That's not an assertion that is actually the truth that Medicare and Medicaid pay below the cost of delivering the care. And that deficit by the way has increased year by year to now it's more than 80 billion. Oh no it's about 80 billion dollars underpayment in 2018. By Medicare and Medicaid underpayment by versus the cost of delivering the care.
Guy Benson [00:07:04] And just to jump in, there are all sorts of surveys of doctors and hospital administrators saying if this became then mandatory or very widespread where we would be forced into these situations doctors would retire early people would maybe not go into that profession and there are medical facilities that say we could not survive we would go out of business which would cause all sorts of problems for access to care. As you said before the whole point of this is care. It should be care not coverage.
Dr. Scott Atlas [00:07:35] Right. So the second just something that's the first point of why public insurance is cheaper it pays less than cost. Now the consequence of that before I get into the second thing the consequence of that underpayment is that who ends up paying for that cost? Because that costs, it's not like doctors and hospitals keep giving care for less than costs. They get their money by shifting that deficit to the people with private insurance. That is one of the main reasons why private insurance explodes and costs. The more people on government insurance, private insurance gets more and more expensive.
Guy Benson [00:08:16] To compensate to make the dollars make sense.
Dr. Scott Atlas [00:08:19] Right exactly.
Guy Benson [00:08:19] That and that in turn it seems to me just using basic economics. If that cycle continues more people who are getting hammered on private insurance they're saying well why am I going to keep paying these bigger or higher prices. I might start shifting to the cheaper government option.
Dr. Scott Atlas [00:08:35] No. Well. Well I mean it what it does is because of the other fact that private insurance provides better care better outcomes more access to care. It turns out that. Only fewer and fewer people can afford private insurance. Sort of what you're saying.
Guy Benson [00:08:52] Correct.
Dr. Scott Atlas [00:08:53] Now the second reason I'm sorry we don't have another hour to go but the second reason here why public insurance is cheaper than private insurance is because public insurance options restrict access to care. There is less access technology less approval of drugs delay and access to new drugs less access to specialists less access delayed access to surgeries. How do I know this? Because this is the fact from looking at the data of every single payer system in the world. And the fact of the matter is that those restrictions of care by single payer systems all over the world have a consequence. What's the consequence? More deaths, more disability, worse outcomes from every significant disease-- stroke, heart attack, cancer, high blood pressure, diabetes. This is the factual data in the medical journals that is ignored or hidden by advocates of single payer. Other countries with single payer systems have worse outcomes by medical data than our U.S. system.
Guy Benson [00:10:07] So I actually want to push on that exact point because we hear frequently from advocates of single payer Bernie Sanders and everyone on down exactly the opposite of what you just said saying like we are way behind the rest of the world look at the rest of the industrialized world. They figure out how to do this. They spend a lot less per person on health care and they have better outcomes. We're way behind the curve. What is wrong with America? We need a revolution now. There are political problems with that people overwhelmingly like their private health insurance. Want to keep it and the Bernie bill endorsed by many people running for president would throw a 180 million people off of their private insurance. But Doctor can you stick around with me for one more segment. Sure because I want you to address this point because it is I think the most salient point in favor of single payer when you bring it to the American people they say. OK that's interesting that makes sense to me. Why is that. You're saying it's not true and I want you to explain why it's not true. Right after this break guy mentioned with Dr. Scott Atlas here at Hoover on this Friday it's the Guy Benson Show.
Guy Benson [00:00:00] Eyes toward the weekend here on the Guy Benson Show. We rarely hold guests over for multiple segments. But in this case there were too many important pieces that we're going to be left on the table. So I've invited Dr. Scott Atlas here at the Hoover Institution to stay with me one more segment. He is one of the foremost experts in the world on the perils of single payer health care. This is something that conservatives need to be fluent in as we have these debates moving forward. And frankly if you're on the fence about single payer health care. These are facts that you need to know because you probably won't get them in the soundbites. So doctor you're about to say and you've written about this extensively. I posed the challenge to you. We hear it all the time from advocates of single payer health care that America is like in the dark ages when it comes to our health care. Everyone else in the industrialized or modern world has figured out some form of single payer. They do it for much cheaper than we provide health care here and their outcomes are better. What is your response when you hear that.
Dr. Scott Atlas [00:01:02] That's completely wrong. It is factually incorrect. The outcomes from every serious disease in the peer reviewed medical literature are better in the United States than in those countries and in fact then in those countries the very model the so-called for the people who advocate single payer England Canada Western European systems. I mean just as an example I said it earlier but the fact is that the U.S. has better outcomes from almost all serious diseases. That means better outcomes from cancer-- common cancers, as well as rare cancers, men and women the best in the world by the way.
Guy Benson [00:01:39] Better like like survival rates and that kind of thing?
Dr. Scott Atlas [00:01:42] That's right. Better outcomes from high blood pressure not only diagnosis but better treatment outcomes than all of these other systems better outcomes from diabetes, stroke, heart disease. These are the most important diseases I could go on. But if you if you get every of the every one of these diseases you know there's no there's no question about it. Now why would they have better outcomes? You might say because you know we're in the 21st century doctors are training. By the way, it's the American doctors who go and teach all the other doctors. We go as invited speakers, they come to our courses-- the other doctors. But that that's sort of a esoteric point.
Guy Benson [00:02:19] That's an important one though I think.
Dr. Scott Atlas [00:02:21] Yes. Well I mean just look at what single payer is do that result in their worse outcomes. They impose long waiting lists for care and these waiting lists are not just long and unconscionable but they're unheard of in the United States. In the U.K. alone, over 4 million patients are on their own NHS waiting lists. One hundred thousand waited longer than six months in the most recent data for the time to get a doctor appointment. In Canada last year the median waiting time between senior GP and just getting the secondary appointment with the specialist was over 10 weeks. The median wait in Canada between seeing a doctor and beginning treatment was five months. Four months to see an orthopedic surgeon five months for a neurosurgeon. That's crazy. This is unheard of. This literally does not happen in the United States. Let's talk about diseases. In England patients referred for quote on quote urgent treatment for cancer. That means the diagnosis was made the referred for urgent treatment. More than 19 percent wait more than two months to begin their first urgent cancer treatment. OK. One out of five patients referred for brain surgery. Wait where's the data here. They wait more than four months after the diagnosis. OK. This is unheard of.
Guy Benson [00:03:47] And this is because of rationing. You know, the government is running everything. And so they there's only so much care to go around. Government is top down control. They're saying all right, sorry. You have to sit there you have to wait.
Dr. Scott Atlas [00:03:59] Let's look at drugs OK. Drugs are the sort of hot button issue right. Prescription drugs. If you take the most recent data. Of the 45 novel drugs in 2015 that were approved, two thirds were approved in the U.S. and available for patients before any of these other countries. England has its own new system of a budget impact test for new prescription drugs. They take an arbitrary number, and if they anticipate it will exceed the payment for that they give themselves three years to negotiate a better price and they don't approve the drug. Well if he had cancer what do you think that does to your your survival? We don't have that kind of system here, and the difference is we have better health outcomes.
Guy Benson [00:04:41] And we also drive so much of the innovation that leads to lifesaving care and new treatments here in this country that's part of why our system is in fact expensive. Doctor we have two minutes left. I want to explain though they will point often to life expectancy and infant mortality rates saying look the U.S. the numbers are kind of crummy. Your response.
Dr. Scott Atlas [00:05:02] Yeah. The response is and there's a piece if you want to look it up in the Wall Street Journal I wrote on infant mortality and life expectancy. This is sort of a total misleading almost fraudulent way to look at health care systems. If you look at life expectancy alone there are dozens of inputs into what determines the length of life that are very different from the health care quality-- personal choice, makeup of the population. There is all kinds of things that go into it. It's called a dirty statistic. It's not a statistic that evaluates at all really the quality of health care. Infant mortality is another it's very attractive to look at it but we calculate we calculate every infant birth as a single respiration, a single heartbeat no matter how premature no matter how tiny. In countries in Western Europe, they don't count as a live birth a baby unless it survives 24 48 hours unless it's of a certain size.
Guy Benson [00:06:00] So the counting is completely different.
Dr. Scott Atlas [00:06:01] It's a complete distortion of the statistic.
Guy Benson [00:06:04] And on the life expectancy point as well, you look at instant gunshot wound deaths or traffic deaths right where people are killed instantly. If you get rid of those factors America's life expectancy numbers go way up and that is not a reflection at all on health care it's exactly a societal thing.Doctor, unfortunately we're out of time but we're gonna pick this up again. We're gonna be having this debate I think for a while in this country. Scott Atlas medical doctor he's a senior fellow here at the Hoover Institution. Thank you Doctor.
Dr. Scott Atlas [00:06:32] Thank you very much.
Guy Benson [00:06:33] And we'll be right back.