SIO156: Healthcare Policy with Dr. Richard Schloss

Transcript

This transcript was generated automatically and may contain errors — the audio is the record.

0:00:28 Thomas: Hello, and welcome to Serious Inquiries Only, this is episode 156, oh, that's one of my favorite songs by the band Mew, 156, check that out, just for fun, and later albums, anyway, unrelated to all of that, Today, I've got Dr. Richard Schloss here to talk about healthcare, to talk about policy, to take about Medicare for all versus single payer, a little bit of the history. He's a physician, he's got experience, he is also an atheist, he heads up an atheist group we're going to talk about. Really cool stuff, interesting conversation, a chance to learn more about policy because I think it's going to be very important coming up in the next several elections here, and So I think it's a great chance to learn more about it. So let's get to it.

0:01:21 Thomas: Richard Schloss, thank you so much for joining me, how are you doing today?, I'm doing great, I'm happy to have you, I, I am really excited to learn some more about, about healthcare policy and other things from somebody who has some, some real experience and knowledge of the subject, and, but also, before we get to that, I know you're president of the Long Island Atheists, and I just wanted to learn a little bit more about you and your background and how you came to, you know, know be part of that group and become president.

0:01:23 Richard: My pleasure. I'm doing well. How about you?

0:01:42 Richard: That's correct. Okay. Well, first, let me say Long Island Atheist is a local partner of American Atheists. So we've got that going for us, the connection to the national organization. The group started, I think, back in 2008, about three presidents ago. And it started as just kind of a monthly get together in a bar, have a few drinks and schmooze. And at the time, it was just called Port Jefferson Atheists. Port Jefferson is a town out here in Long Island. And then as more people started to come from other parts of Long Island, they realized that it had a broader appeal, so they changed the name to Long Island Atheist. And then it moved to a Whole Foods. That was about when I joined, which was maybe about 2010. 10. And we kind of percolated along that way, just having our monthly get together and bull session.

0:02:37 Richard: And then the last president to take over was a young, very ambitious, enthusiastic man named Thomas Sheedy, who now is up at Albany getting his degree in public policy. But but he decided that first of all, he was the one who got us affiliated with the national organization, Recovering from Religion. And he also decided that we needed to be more than just, you know, a place for people to come in and rap. And so he added a lot of activities which became very popular. Like we have a hike once a month and we do we try to do some public service. We added an activity that we kind of borrowed from other Long Island, from other atheist organizations called Drinking with Atheists.

0:03:25 Thomas: Always popular.

0:03:26 Richard: Always popular, right? We have a diner group. We have our monthly meeting at a Panera. So we've got a lot of different things going on. And it helps the membership because people, Long Island's a big place. You know, it's 120 miles end to end. And some people find it easier to come from, you know, who live on the western side, find it easier to comes to some of the meetups, but not ones that are that are too far east, and vice versa. Some people read rather come out on a weekend, some people would rather come on a weekday. So this way we can kind of be, try to be all things to all they all atheists.

0:04:01 Thomas: Yeah.

0:04:01 Richard: At least, you know, that we don't exclude. I mean, we've had people who are Christians come to our meetups because they were just curious, you know, and they really thought it would just be all of us talking about how I agree you are. A God and.

0:04:10 Thomas: Yeah. Of. Course.

0:04:12 Richard: You. Know. And right and how.

0:04:14 Thomas: That's. Always.

0:04:14 Richard: Much.

0:04:14 Thomas: Weird.

0:04:14 Richard: We. Don't.

0:04:15 Thomas: I. Never understand that, why. It's, I guess it's easier for them to think we're mad at God than it is to confront what we actually think, I guess, I suppose, I.

0:04:16 Richard: Right.

0:04:24 Thomas: Don't know, wow.

0:04:25 Richard: And. Uh, you know, how much we don't believe in anything, and you, um, they were kind of surprised to see that, uh, you know, we're really into protecting church-state separation, which they could support, and, uh, you know, trying to do good things for the community, which they can support, and other than the belief in the supernatural, there wasn't that much difference between us, which was very educational for them. So that's kind of what they're about, and that's how I kind got involved with the organization.

0:04:49 Thomas: That's really neat, that sounds fun. And, and, uh, for your personal background, you're a doctor, correct? What, what, uh, what area of medicine? Hmm.

0:04:56 Richard: Okay, yes, I am a physician and my area of specialization is psychiatry.

0:05:00 Thomas: So much to talk about. That's really great to hear about that group. That sounds like a lot of fun. I couldn't be further away geographically from it, but if I tried and still being in the United States, I guess I could move to Hawaii, I suppose, but pretty. Much all the way on the other side. I'm in Sacramento, California. So all the way.

0:05:13 Richard: Whereabouts are you?

0:05:17 Thomas: That's pretty far. Yeah. I don't know if I can make that drive, but I wish I could. It would would be fun. I'll check you out if I'm in the area. But I know I have plenty of listeners out there. So that's a good, great advertisement for that group, because it sounds like a lot of fun. But I wanted to talk to you a little bit also about healthcare policy, because it sounds It's something you've got some not only interest in, but firsthand knowledge of. And I'm really interested in discussing the basics, and maybe your view of Obamacare and how that went down versus where we are now and versus where you might like us to go. I know that's a big topic, but what do you think?

0:05:34 Richard: Sure thing.

0:05:55 Richard: Yeah, that covers a lot of

0:05:58 Thomas: Yeah, it gives us a lot to do for the next 30 minutes or so.

0:06:03 Richard: Thorny ground. But okay, so let's start with the generalities and move into more specifics. Things. So the first glaring generality is that we are the nation that generates the most wealth of any nation in the world, but we're also the only developed nation that doesn't cover all of our citizens as far as access to healthcare.

0:06:23 Thomas: No kidding.

0:06:23 Richard: And just a crime. I mean, there's no other way to put that. So, the question becomes, what are we doing wrong? You know, and if you look at all the figures, everybody's seen the figures. We spend more per capita on healthcare than any any other country, but yet our citizens are not healthier. In fact, in most cases, they're less healthy than places like Canada and Western Europe, Scandinavia, that kind of thing. So again, so the question becomes what's, what's going on? What's, What are we doing wrong? And it's, it's basically, you know, the approach, um, the that those other countries take is we want to make sure everybody's covered. We want to try to make everybody as healthy as possible using the resources that we have. Whereas the approach in this country is we We want to try to wring as much profit out of health care as we can, and hopefully we'll help a few people to get healthier along the way. That model doesn't work too well because health care is something that everybody's going to need at one time or another, but we have tremendous income disparity in the United States.

0:06:36 Thomas: Yeah, yeah,

0:07:26 Richard: That means that some people can afford to buy a lot more health care than other people, and that automatically sets up a conflict whereby some people are not going to be able able to afford as much health care as they need. So that's where the government comes in. And the government has tried to help out. We have two government programs, principally, which are Medicare and Medicaid. Medicare is federally administered. Medicaid is generally state administered. And Medicaid goes by income. And Medicare goes by age or disability. So they filled the gaps of the people who were most difficult to insure privately, which were the elderly, who tended to be the most sick, the people are chronically disabled, who tended the need the the most care also, or the poor who couldn't afford care. So that was a good thing, but we're still falling very short in terms of people who are what are called the working poor.

0:08:17 Richard: So they may not make enough money to be able to buy their own insurance. They may be underemployed. So they're not getting coverage for their employer. And these are the people who wind up not having having a primary care physician and going to the emergency room when they get ill because they can't afford to see a private doctor. And so the hospital generates a large bill and has to eat the bill or other people wind up having to subsidize that. And they're still getting, you know, substandard care.

0:08:48 Richard: So I'm just kind of summarizing everything that's wrong with our system.

0:08:50 Thomas: Yeah. It's very useful.

0:08:54 Richard: Is, what can we do about it?

0:08:55 Thomas: Yeah. Well, can I pause you? First off, I was thinking one thing that I want to emphasize when I'm, I don't know, speaking with atheists, I think for the most part, by the numbers, atheists are pretty liberal. But one thing that I think maybe we could do better or more if we wanted to, because I tend these days, personally, I just tend to care more about politics and policy than I do about atheism in and of itself lately, just because of the direction of where the country is going. Um, but I think, I think there's a strong tie in there though, because I think we could do more to make the case about moral luck. Uh, it's

0:08:57 Richard: So, absolutely.

0:09:23 Richard: Okay. All right. Uh-huh.

0:09:35 Thomas: Something that, uh, I have a philosophy podcast and something, my, my partner is a philosopher on there brings up all the time as a, as a phrase is moral luck, you know, it's, it, it. It's interesting. I feel like it shouldn't be an atheist versus Christian thing, but somehow it is, you know, like somehow there's, uh. A right-wing view that if you're poor and unhealthy, you kind of deserve it or something versus what I think should be a more compassionate atheist, or even, I mean, it even makes sense if you're a Christian, but anyway, atheist view, which is, you know, there's a whole lot of moral luck. You know, There's nothing that you or I did to be born here. I'm assuming you're born here, born wherever we're born. You Know, There'S nothing I did. I don't remember anyway, doing doing anything, making the decision. Good thing I was so smart. I wasn't born, you know, in some war-torn country somewhere that's even worse.

0:09:58 Richard: Yeah. Yeah, good thinking on your part there.

0:10:27 Thomas: Thank you. Thank you. Finally, I'm getting the credit I deserve for that. Yeah, and tying that in with policy like this, that should be, I would think, a no-brainer. What do you think about that connection? Do you see a connection there between kind of the atheist movement or your atheist group versus policy like this, or do you try to keep it separate?

0:10:48 Richard: Well, I mean, we're not an overtly political group. I will tell you that by default, almost everybody in our group is liberal, because it just tends to happen that way. But I think you're right. I think there's that odd dichotomy in American Christianity, And especially since the identification of Christians with the right wing is that, you know, what does the New Testament teach us? You know, Jesus cared for the poor, and

0:10:54 Thomas: Right. Yeah. The exact opposite of the entire Republican platform is what the New Testament teaches us. It's the most bizarre thing. I will never understand it.

0:11:14 Richard: Right, you hit the nail right on the head, you Know. But I will say that my wife was recently in Salt Lake City for a conference, and, you know, Salt Lake city is Mormon central, and she was riding in an Uber, which of course was driven by a Mormon. And she remarked about, you know, how clean and neat, tidy Salt Lake City looked. And the driver said, oh, well, you Know, it's not all, you know, terrific, because we do have a large homeless population. And she said, Well, I find it surprising, I would think the Mormon church would want to step in and do something about that. And he said, well no, because what we what the church teaches is self reliance.

0:11:31 Thomas: Right. Yeah. Yeah, yeah. Self-reliance, except you have to give us 10% of your income or whatever it is. Self reliance for everybody else.

0:12:09 Richard: Right, but we'll still take, uh, you know, ten percent of I think

0:12:11 Thomas: Yeah what is it 1015 I can't remember the more

0:12:14 Richard: It's tithing is ten percent.

0:12:15 Thomas: Yeah, tithing. Yeah, exactly. Yeah. It's, that's, it's such a weird thing. I couldn't be a more Jesus-y Christian thing than to want to provide healthcare for people who can't afford it. But anyway, I suppose back to the, to the healthcare talk, what were your feelings back in 2008, you know, 2007, 8, 9, 10, when, when Obamacare was being proposed and worked out? You know, I did an episode a while back on the history of that and I always mix up the two terms. I don't don't know why, but single payer versus public option. Now, single payer, I think that was never really on the table, whereas what's his name? Ruined public option, the Gore's VP. Was put the stop to that.

0:12:16 Richard: Right, yeah. Yeah, uh-huh.

0:12:41 Richard: No, Never, yeah. I don't recall, but, uh, yeah, um, yeah, public option was never really entertained. It was, it was always designed to be, you know, a, a, uh, sort of like a cap. That's not the wrong word, but an appendage, you know, fitted over our proprietary health insurance system. But, you know, when it was first proposed, I said, this is great. This is a step, and a big step in the right direction, you knows, towards, because we had, at the time we had, what, 40 million people without health insurance? You know, and I said, this is, at least we're going to cover most of these people. And, but what, what we needed was that public option, because what that was going to do was step in and cover people who still fell through the cracks, who still, you know, couldn't afford health care, even with subsidies.

0:13:43 Richard: And, you Know, we're not going to be fully covered. And so the idea was, yes, you know, we'll subsidize you up to a point. And people who just absolutely don't qualify for Medicaid but can't afford, you know, any reasonable health care through the Affordable Care Act will have it paid for by the government. And, you Know, they wiped that out. So that was gone. And I think that greatly weakened, you know, the benefit of the Affordable Care Act because immediately you added back, you know, 10 or 12 million people who were not going to be able to get health insurance. Um, so there was that problem. And, um, so I think that, that affordable care act as good as it was compared to what we had was, was kind of fatally weakened from the beginning.

You know, the, the last thing that the Trump administration just did to it, uh, well, they got Congress to vote on it, obviously, but, uh. Which was to remove the individual mandate, uh really just, you know, kick the legs out from under it because the mandate was the only way to fund the system because every, Every every health care system depends on revenue from younger, healthier members to pay for the additional care that older and sicker people are going to need. And if you don't require younger and healthier people to buy into the system, then you can't fund it. So so this I think was was really kind of, you know, if not a fatal shot, it was it was definitely a mortal wound. You know,

0:14:18 Thomas: Yeah. Yeah, right. Yeah yeah.

0:15:03 Thomas: And then they kind of put this paper just to clean that up a a minute ago that was Joe Lieberman, he threatened to veto the bill, uh, if yeah if they if they included uh he threatened, sorry not veto, he threatened a filibuster the bill if uh if if it had the public option, he really did single-handedly murder that for some reason, um, in 2009 or so, but uh, but yeah, and then they paper over that where they got rid of the individual mandate, uh, I couldn't, I couldn't keep track that they did get rid of that in the uh, I thought they, hey, was that the one that McCain voted down or did they get rid of that in the tax bill somehow?

0:15:08 Richard: Good old Joe. Yeah.

0:15:38 Richard: I think they got rid of it in the tax bill. McCain voted, I think, McCain voted to, because they were going to eliminate the ACA altogether. And McCain, yeah, that

0:15:41 Thomas: Yeah, he's right. Yeah, yeah. He stopped that. But so, yeah, I think they they chipped away at enough stuff via the tax Bill to make it functionally not not the same. And I love the the option or the solution that they proposed in that skinny repeal was, well, as long as we put put all the high risk, high cost people in another pool, like a high risk pool, and then not fund that, then we'll be fine. It's like, yeah, it's Like why are you even doing that? It's just to make, to look like you're doing something. And that's what's been so frustrating in all this, in covering, you know, I covered that pretty closely. Now it's been, what, a year or so or something feels like forever since healthcare was really being debated again.

But one thing that that frustrated me to no end about it, which I think was so obvious if you were paying attention, was even though Republicans campaigned and campaigned that Obamacare was the devil and were able to wipe out, just absolutely obliterated the House and a lot of the Senate races in 2010 just because they were able able to make it so scary all the while not having any plan of their own, you know, and it really was, it was just so predictable and embarrassing to see them grab every single, uh, you know, branch of of government

0:16:08 Richard: Was pretty much the solution, yeah.

0:17:07 Thomas: Power in 2016 here and have no plan for for health care and not even be able to pass something because they just wanted a bunch of things that are contradictory. Um, and I, I don't know what the solution to that is, but it, but it is one thing where, are we ever, do you, do you think we're ever going to be able to pass anything when then there's that kind of ability on the right to to fear monger over something like Obamacare, which largely was a great policy, and by the way, was funded, it actually funded itself, yeah.

0:17:41 Richard: Yeah, that's an interesting part. You know, they're always, you know, wanting to say, well, we won't pass this unless the funding's there. And hey, the funding was there. It was actually cheaper than the alternative. But yeah, there was a lot of, well we're going to repeal this and replace it with nothing. If you remember Trump saying, we're going to get rid of Obamacare, and we're going to give you cheaper coverage and better coverage, and then when

0:17:43 Thomas: You're Right, yeah. Yeah. Yeah. Cheaper Coverage, more doctors, more, it was just more everything. I mean, it's the most obvious con job in the world to everybody except the 40% or whatever that support him still.

0:18:13 Richard: He finally sat down and actually looked at the numbers, his response was, well, who knew real healthcare was complicated? Who could predict

0:18:19 Thomas: Yeah, nobody, I know, that's what it is for everything that he doesn't understand. What he just means is, oh, I didn't know this, but it's, no, who knows? Nobody knew. Nobody knew how complicated it was. Yeah. So, how do you think Now, I guess we can we can entertain some hypotheticals, you know, assuming Democrats do get back in trouble. Or actually, we don't even have to say that. If you were and you are a voter, obviously, but if you are either a voter or a Democrat running for office right now, what would be your message regarding health care? What do you think would be the way to try to get people on board with the right policies here? Right.

0:18:23 Richard: It? Right. Well, I think the message should be that we can cover everybody. We should cover everybody and that it's immoral, pretty much, not to cover everybody, you know. That would be my message. I don't know how that would resonate. But OK,

0:19:13 Thomas: Yeah. Yeah, and if we want to get more specific, can you define what exactly is the difference, again, between, and sorry, this is a basic question, but sometimes I get a little mixed up, with single payer versus like Medicare for all, what do you see as the differences there and what do do you prefer?

0:19:35 Richard: OK, well, Medicare for all would be just taking the current Medicare system, which is a government administered system, and expanding it to cover everybody in the country. And actually, Medicare runs pretty well when comparing it to private health care systems, because you don't have to set aside 80 percent of the proceeds for profit. So most of that can go back into paying for health care. So the overhead becomes much lower. You still have the administrative costs, but there isn't so much getting pre-approvals and reviews and denials. So the whole thing becomes much more efficient.

0:20:13 Thomas: Right. Yeah.

0:20:15 Richard: Does That, yeah.

0:20:15 Thomas: And I can pop in with a word on that because I actually worked in ophthalmology practice. I was the accountant, but I worked for one for about six years. And it was just absolutely ridiculous, the kinds of stuff that insurance companies would do. I mean, and actually, honestly, the government ones, I think we had Medi-Cal in California. California.

0:20:37 Richard: That's their version of Medicaid. Right. Your version.

0:20:38 Thomas: Right. Yeah. And honestly, you know, they were some of the worst in terms of how in terms of actually getting paid, you Know, but I think that's a product is something that could be fixed in policy, Whereas for the the, I think that's a, that's a bug, not a feature. But for the private ones, I think it's a feature, not a bug, which is, I mean, that they were in the business, of these insurance companies were in the business of trying to screw with us as much as possible to increase their margin. And by that, I mean, I'm sure you probably have experience with this as well.

Every time you turn in a claim, every so often there's a new form, and if you didn't do the form exactly perfectly right, and they would switch it up as often as they could. And if you didn't do this for them exactly correct, they would, they would deny your claim. And they're just trying to find any nitpicky little tiny way to deny your claims so that you don't get paid and they can profit off of, you know, the doctor's office having done some work for free, essentially, essentially. Uh, and that's, it's, it just seems so unnecessary, you know, like it really

0:20:39 Richard: Right. Yeah. Right. Yeah. Oh. Yeah. Right. Yeah.

0:21:41 Thomas: That middleman. If there's ever a job for government, in my opinion, it seems like that would be it, right, like eliminating that just nonsense transaction that we shouldn't have, you're

0:21:47 Richard: Yeah. You're absolutely right. And yeah, they'll deny claims on the basis of, well, you didn't fill in field 15H, which we just added on the form. You know, right. But um, you know, and the other complaint that that, uh, people on the right will often use to try to argue against, um, either Medicare for all with single payer, and I'll get back to distinguishing the two of them.

0:21:57 Thomas: Right. Exactly. Yeah. Right. Yeah, yeah. Sorry. I Did, sorry, I took you off the topic a little bit.

0:22:12 Richard: That's okay. Yeah. Let Oh, yeah. Well, what you're going to do is you're gonna introduce rationing. Well we live with rationing, we have rationing in this country for years. And yes, the other countries I mentioned also have rationing but it's why you're rationing that makes the difference. The other countries have ration. Rationing?

0:22:27 Thomas: Well, can you explain that, what, what do they think we're rationing that we aren't? Yeah, I guess I don't fully understand that.

0:22:29 Richard: Yeah. Okay. Well, right, right. Well they're saying, well, you know, if you, if you give it to the government, the resources are limited. And so the government's going to ration how much healthcare you can get. Well. Right. Well yes. In, in Canada and the UK, the government rations healthcare based on need. Those who have the most need get more of the resources. Those that have less need or less immediate need get less of the resources. So So you might have a little bit of wait time if you have something that's not immediately life-threatening. So that comes across as rationing. But in this country, we have rationing based on maximizing profits.

0:22:41 Thomas: Oh, right. I see. Yeah.

0:23:10 Richard: So the insurance company won't approve this because they deem it too expensive, not because you don't need it, but because they just don't want to pay for it. So that's where the rationing comes in. It's rationing, but it's a much crueler form of rationing, whether you call it rationing or not. We call it managed care. You know, it's that's basically rationing. So but anyway, to come back to how Medicare and single payer. Now, single payer just implies exactly what it says, that one single party pays all the bills. Not that you have fifteen hundred different companies and some people are paying out of pocket and some people are going through their insurance company, et cetera, etetera. You have one entity. Now, that entity could be a government agency, but could also be a private company that's contracted to work for the government. And I think in some places that's the model they use, like I don't know if it's Germany or the Netherlands, but they have a kind of a hybrid system there where the government contracts with a single company to administer health care.

0:24:07 Richard: But it still cuts out the confusion of who do I build this to? Everyone is paying a different rate. How do I know what to bill? You know, this company will approve this procedure, but not that procedure. And the other company is the opposite. And so it gets rid of all that confusion.

0:24:17 Thomas: Yeah, yeah, Absolutely. So do, I'm seeing people campaigning on these two different things on Medicare for All versus single payer, and I guess I don't know, is there one, do you, do you wish people were campaigning on one or the other, do you, what do you think we should do about that, or is just honestly is just anywhere more better than where we are, so like, who cares, the kind of thing, and we'll figure it out once people are in office? No,

0:24:46 Richard: Yeah, I mean, I think either one would be preferable to what we have now. I mean I think it might differ a little bit in terms of funding, because with a Medicare for All system, it's absolutely going to come out of your taxes. And so people see their taxes go up, and they're running through the streets with torches and pitchforks. And Michael Moore explained this best, actually, in his movie Sicko. I don't know if you remember that one. But he said people say, oh, well, look, my taxes are so low. Oh, but meanwhile, you know, I'm paying $1,500 a month for my health insurance.

And then I still have to shell out $100 every time I see the doctor. Whereas, you Know, all my taxes went up, you know, 10 or 15%. Oh, that's outrageous. But now I can go to the doctor if I need to. It doesn't cost me anything out of pocket. And I go to, I can be hospitalized and not worried that I can't afford the hospital bill. So in the end, you wind up with more money in your pocket. It's just that, you know, it was taken out up front as opposed to

0:25:09 Thomas: I didn't see it. Right.

0:25:21 Thomas: Right,

0:25:40 Richard: Having to pay.

0:25:40 Thomas: You're just moving where it happens, like they're just, just moving where the transaction happens. But people get so, so sensitive and angry about taxes that, yeah, I've never understood that. It's very frustrating that we can't get more people on board with that, because it seems so straightforward to me. I mean, sure, your taxes will go up, and then a bunch of other stuff will go away and be way more secure, and you'll be less stressed out about it. You know, I don't see why that's such a hard sell for some people.

0:25:46 Richard: Exactly. Mm hmm. Yeah. And I just I think just in this country, taxes has become a dirty, has has have become a dirty word. You know, I think of Grover, Grover Norquist, you know, and his thing about flushing the government out of a drain hole, that kind of thing. So there's – and making Republican politicians sign a tax pledge that they would not raise taxes. That was Grover Norquist's thing and a lot of Republicans went along with that because it was a way of guaranteeing a primary win. So I think taxes have become this bugaboo and people don't realize what taxes pay for. Just like you pay taxes so you have roads and you pay taxes so you have, you know, a fire department and that kind of thing. So there is that. So a single payer, I think, could be funded by the government. It could still be funded by paying into a private company from your employer or out of pocket. So there's a little more flexibility there.

0:26:14 Thomas: And

0:27:00 Richard: But again, it would still be just one central agency or company that does the reimbursements for everybody. So,

0:27:08 Thomas: Don't you think there's got to be so much savings of time and money there? There? Like, wouldn't there, I mean, I don't know if you've looked at any models of, of costing this stuff out, but like, I just, I have to imagine that would be so much more efficient and so much less stressful for everybody.

0:27:24 Richard: Oh, absolutely. It would be less stressful for the providers because they wouldn't have have to employ a, you know, an office full of people just to straighten out all the billing.

0:27:31 Thomas: Yeah. Yeah, we were, we had a team of people just for that purpose, you know? I mean I guess it's good that they had jobs, but, but still, I I mean it's, it's the idea that we had to have, you know, in a small company, pretty, pretty small company. Not tiny, but not not huge, you know, a room full of people just trying to manage all these different forms and crap that they had to fill out and turn in right, perfectly, uh, you know, and perfectly done. Yeah.

0:27:36 Richard: Right. Yeah. Yeah, It would lower overhead, definitely for physicians. I mean, in my office, I'm a rather small practice, but I have two secretaries, you now, one of whom is answering the phones and logging people in when they come to the desk for their appointments. And the other one is basically on the phone all day, calling insurance companies, getting approval for for prescriptions, mostly, or sometimes for visits. And it's just a colossal waste of time and resources to have to go through that. So there's that. Plus, the people would have peace of mind that they wouldn't fear going to the doctor until they were almost too sick to have something done about it, because they would be secure that it would be covered. That would be a great boon, obviously, to the health of the country. It would be a boon to employers, because employers wouldn't have to worry about, you know, how am I going to buy health care for all my my employees and they keep raising the rates on me.

0:28:47 Richard: And, uh, and now my employees aren't getting healthcare. So they're getting sick and they're, and they going out on, on, you know, sick leave and absenteeism. So it's a win-win all around for, uh for American businesses also.

0:28:58 Thomas: Yeah, well, we've solved it. Let's just, uh, I guess we'll make it happen then, I don't know. I really hope we can, uh, we can bring this energy. It does seem like there's more enthusiasm around these ideas lately, don't you think? Yeah.

0:29:11 Richard: I think so. I think there is a groundswell developing. Of course, you the healthcare health insurance industry is a multi-billion dollar industry. They bring in a lot of money. They have a lot of political friends in Washington. They donate to campaigns, so, you know, so there's... there's the lobbying aspect to It

0:29:27 Thomas: It would be It is a really, in some ways, though, scary thing. Even if you're a fan of single payer, you know, to think, well, we're just going to kind of write out this bajillion dollar industry and just kind of get rid of it. That does seem, I mean, that seems pretty terrifying. Isn't that effectively what would happen? I mean if we, if we sign a new bill, you now, uh, 2020 or whenever it is, we have enough power, uh, that, that mandates this single payer stuff. Does that essentially just put a ton of people out of business?

0:29:42 Richard: Yeah. It Would seem to, yeah, to throw a lot of people out of work initially, which I think is scary. Um, I mean, I think that there should be some form of retraining for these people. Some of them could, I guess, work for the expanded Medicare for all system, uh,

0:30:04 Thomas: Yeah. Oh, they could go work in the coal mines that Trump brought back. Oh no, no, I'm just kidding. Yeah.

0:30:09 Richard: Yeah. Like all these, all these jobs for coal miners now. So There is that, or or they could be re- now that that there'll be more healthcare accessible to people than they could be retrained as, I don't know, ultrasound technicians or something like that. So there would be more jobs in healthcare for them. But, you Know, I recall reading about this, you know and this argument that, well, we're going to throw a lot of people out of work And they talked about, you know, that there are throughout our history, there have been industries that kind of went away and people had to had to be retrained. You know, like what happened to all the telegraph operators, for example. So that sort of.

0:30:15 Thomas: Yeah, yeah. Right, yeah yeah. I think there is something to be said though for, you know, when When something when when an old technology phases out over time, it's a little bit less catastrophic than like, you know, someone signs a bill, an entire bazillion dollar industry just disappears. I think there's... there's something to be said for the severity of it, but I don't think it's the reason we shouldn't do it. I just wonder if there's any. Yeah, maybe as part of the bill, any sort of retraining or something like that might be helpful. Right?

0:31:01 Richard: Yeah, right. I agree with you.

0:31:15 Richard: Yeah. I agree with you there. Before we get too far afield, I did want to share a story with you, which I think will illustrate one reason why I'm so passionate about this, because not only am I a physician who wants to provide the best care for his patients with the least amount of hassle, but I also had the experience of the other side of being a patient and what that's like in the American healthcare system. So about a year ago, maybe a little over a year, yeah, January, February, March, that part of 2017, I managed to come down with two fairly significant ailments, simultaneously.

0:31:36 Thomas: Congratulations.

0:31:55 Richard: Thank you.

0:31:54 Thomas: Or No, yeah. Yeah.

0:31:56 Richard: Well, okay. I mean, it took some doing. So first I developed really severe reflux, which is a very common ailment. It's where acid from the stomach backs up into the esophagus. And if you don't do anything about it, it not only causes pain, but it also can cause ulcerations and ulceration can bleed. And that's not so great. So that was going on. And And then around the same time, I suddenly developed fairly significant pain in my left arm, which which turned out to be caused by a pinched nerve in my neck. So I was going for evaluation treatment for both of these ailments. And what was going on was I had a gastroenterologist I had seen years before just for routine stuff.

0:31:59 Thomas: Yeah.

0:32:45 Richard: And so I said, well, let me go back to this gastroentereologist because I'm having these reflux symptoms. Only the gastroenterologist was not on my new health care plan. So he said, well, I can refer you to somebody who is in our office who is taking your plan. Oh, terrific. Wonderful. So I get referred to this other gastroentereologist who I don't know. But, you know, she's got a recommendation. So that's great. So she does an endoscopy on me and doesn't like what she sees and says, OK, OK, I want to send you to a specialist to have a particular test done that we can't do here, but it's done at this big deal hospital, Long Island Jewish Hospital. And then she'll send you back to me and, you know, we'll figure out what to do.

0:33:32 Richard: So I make the appointment. I have the endoscopy with the doctor at the other hospital who fortunately took my insurance. And in between. Well, let me, I'm sorry, didn't mean to jump around. So I have the test. I make an appointment with my not original, but second guess with their ologist, the one who was supposed to be taking my insurance. Now, I wait two months to see her. And the day before I'm supposed to see or I get a call from her office that they're canceling my appointment because she just stopped taking my assurance. Insurance. So I've got the test results from the specialist now, but I've got nobody to evaluate them. So, I called the specialist, who is a 45-minute ride from my house, and tell her what happened. I said, look, you know my case. Will you see me, since you're still taking my insurance? And she said, yes.

0:34:17 Richard: So luckily, I was able to go and see her, but I had all that hassle with that. Now, as far as the pinched nerve in the neck, Back, I started there. I went to a neurologist, diagnosed the problem. He said, I want you to see a spinal surgeon. Referred me to a spinal sergeant who didn't take my insurance. And he didn't know where to send me. So I had to call the insurance company. And it took them 25 minutes on the phone to give me two names of spinal surgeons within an hour's drive of my house. When I called one office that they gave me, they said, oh, we've never heard of that doctor. When I called the other office, they said, oh, we know who that is, but he's not at this office. So they had to give me a different number. I called them. Finally, they were able to see me.

0:35:04 Richard: And so that spinal surgeon and he said, OK, well, I can't really help you, but I'm going to refer you to a pain management specialist, a management specialist. He referred me to not on my health care plan, back to the insurance company, another half an hour on the phone to get a different referral. So, I mean, I was tearing my hair out at this point. I don't have that much left to begin with. And I'm saying to myself, I'm a physician and I'm finding it almost impossible to navigate the American healthcare system. What is this like for people without the sophistication, without the medical education? What is it like for them? How many of them just give up at some point, you know?

0:35:17 Thomas: And One thing that, uh, I think is, is a part of this too, and and I don't know if this is more product of if we still stick with the Obamacare system versus moving to something, uh, that more, I guess, progressive, but, um, but part of it that I, I, I wouldn't have thought about, you know, until we start getting more into this when the bill was happening a year ago or whatever, is we need regulations on what kind of plans can even be offered because people just don't know what they have. You know, they might buy a plan thinking they're covered and then, you know, your story or even worse happens where they actually have no coverage for anything and their plan is a little more than a piece of paper that still costs them money that doesn't really do anything for them.

0:36:30 Thomas: So regulating that end of it, too, where, you know, what kinds of plans should they have to have? What kind of standards and what kind of coverage should the plan have to include to even be considered covered, you know, when it comes? But I suppose maybe single payer eliminates that, right? That's more if we stick kind of with a hybrid system.

0:36:43 Richard: Right. Yeah. But there again, you you know, that, that was one of the triumphs of the ACA was getting rid of the exclusion for preexisting conditions. And that was One of the first things that Trump tried to attack was, oh, we need to, to get rid of this, you know preexisting condition, exclusion, allow them to exclude for preexisting existing conditions again. Because, you Know, that gives the companies a reason to deny claims. And a lot of people have preexisting Conditions, it's just the nature, you know most, most healthcare problem, most health care problems are chronic. We don't,

0:36:58 Thomas: Yeah. Yeah. I kind of feel like life is a preexisting condition. I mean, yeah,

0:37:24 Richard: Right. Oh, you were born. Well, now it's a free association.

0:37:27 Thomas: I mean you're not, you're going to have a condition at some point. There's no, you know, like it's going to happen, you know, so how would, how do you think this would have looked under, you know, Medicare for all or single payer? How would your, how Do you think your story would have, have gone?

0:37:33 Richard: Right.

0:37:44 Richard: Oh, well, what would have happened was my original gastroenterologist would have had no reason not to, you know, to deny me seeing him because he'd be taking the Medicare for all or the single payer. So that that would have ended right there. And the same thing with, you know, the the pinched nerve problem, the neurologist would have referred me to the spinal surgeon that he wanted me to see who would have seen me because there wouldn't have been any question about coverage, and he would have sent me on to a pain management specialist who would've been covered and there wouldn't have been all this hassle about every time I got a new referral. It was to a doctor who wasn't on the plan and having to go back and call the insurance company and waste a half an hour on the phone waiting for to get a name. So it would have made life a lot less stressful.

0:38:26 Thomas: Right. But you would have had to be worried about what your death panel was going to say about you, right?

0:38:31 Richard: Oh, the death panel, I forgot about that, though, yeah.

0:38:32 Thomas: Yeah. Yeah. That does sound a lot better. You know, one thing that I found kind of interesting and encouraging was, you know, people talk about there could still be a role for private insurance. You know, if somebody, if we have a high baseline for everybody, but, you know, maybe you're more well off or maybe you're somebody who is just more worried about health care for your family or something like that. You could buy an additional, you know, private plan or have some sort of private care that would, you know, I don't know if it's a private office or something where you wouldn't have to wait as long or something. I mean, what do you think about that idea of still having, you know, room for private business there?

0:39:13 Richard: Absolutely. And that's one of the things that, um, either could be appended to a Medicare for all plan, because we don't really have that with the current Medicare system, or, um, with a single payer, is, is have the option for people to buy private care separately. People who can afford it can go outside the plan, pay out of pocket if they want to, you know, even have something like concierge medicine, and that would be available. So it wouldn't be like, well, you know, everybody gets the lowest common denominator. No, you know, people could opt out and pay more if they so chose, but people who were in the plan would still get, you know, they would still a minimum acceptable standard of care.

0:39:55 Thomas: Right. Yeah, I totally agree. And I would want that minimum acceptable standard to be quite high, personally. Obviously, but once that's covered, then, you know, okay, Americans, you can have your precious inequality if you really want it. Well, what do you think? Any other thoughts? I guess we're already coming to a good time here. What do you thinks? Anything we didn't cover that you want to make sure people are aware of regarding this?

0:40:03 Richard: Absolutely.

0:40:23 Richard: You know, the hardest part is going to be kind of winning hearts and minds, you know, and converting people to the idea that, A, there is a moral imperative to covering everybody and that, B, it's not going to mean that, you Know, you're going to be poor now, because you're paying for somebody else's health care. I think that's the fear, you know, you take my money, I'm not paying for my health care is paying for somebody else health care, how is that fair? You know? Give people the idea The idea that shared responsibility doesn't mean that we're robbing healthy people to pay for sick people. It means that you contribute to the system to help people who are in need now with the understanding that when you're in need, the money will be there for you, whereas you might not have been able to afford that care on your own.

0:40:26 Thomas: Yeah. Absolutely.

0:41:11 Thomas: And also, I think in terms changing hearts and minds, as you said. I mean, just emphasizing, I don't think it's very controversial, but just getting it out there more that our current system is so bad. You know, there's so much inefficiency and we're paying so much more as a country than we should be per capita. It just seems like such a no brainer. And it's, I hope it's something that, you know, maybe we can help generate a little enthusiasm for and take that enthusiasm to the voting box and make some change happen.

0:41:42 Richard: Here, here.

0:41:44 Thomas: All say, okay. All right, well, Dr. Richard Schloss, is there anywhere we should send people? Do you want to send people to a Twitter, a website, anything for the group, the Long Island Atheists?

0:41:54 Richard: Well, we're still working on the website. Site. It's liatheist.org. But if they want to go on to meetup.com, we have a large meetup presence. We have an official Facebook page. So just look up Long Island Atheists on Facebook and you'll find our page there with a lot of discussions and notices about our events. So that's probably the best way to get information on the group.

0:41:56 Thomas: Okay. Oh, yeah.

0:42:17 Thomas: Excellent. Well thank you so much for taking the time to educate us a little bit and And I really appreciate it. And good luck with everything. I hope your health care issues are doing better than they were in the story you told. Good.

0:42:30 Richard: They are. And thanks. It was a pleasure to be here.

0:42:33 Thomas: Yeah, absolutely. Thank you so much. It was a pleasure to talk to you.

0:42:36 Richard: Okay. Bye-bye.

0:42:59 Thomas: I want to give another big thanks to my guest, Dr. Richard Schloss, interesting interview, and I learned a lot, and, also, if I would like to support the show, please go to seriouspod.com support, or patreon.com/seriouspod, either one, gain access to bonus episodes, and more, and the Facebook group, and all that stuff. Thank you so much to all who support the show and make it happen and with that said I will see you next week