Tarik Sammour: Healthcare, Big Pharma, Inflation & Outcomes - MOB019
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Ob city rates in in the U. S, for example, they shot up dramatically after the one thousand nine hundred and seventies, and they haven't really come back down. Now i'm looking to blame. See at all, anything like that is not my argument.

My argument really is that, we used to have low time preference because our money worked and IT made IT incentivize us to save and think long term。 And one of the issues we have today is that we don't think long term, we think very short term. And that creates all sorts of negative consequences. You know, you're more likely to drink, you're more likely to smoke, you're more likely to eat unhealthfulness, you're more likely to gambol. You're like to have all sorts of disorders as a result of the fact that a lot of people are disillusion with their own future.

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Thanks for having the beater ready to be here.

Well look um as you know health care is the subject is really interested in um fascinated and like the design healthcare systems because of say I live in the U K. British people historically love the N H. S.

So we were very proud of is absolutely fucked right now. Um uh I always been about time in the U S. I think this system is terrible. Um so lots of libertarians who would keep telling me that, uh uh, socialized health care is a disaster um but countries without socialized health care uh seem to be slightly less civilized if you ask me because you're in a situation when like people we looked at so i'm just like the fucking man well.

I mean, I think I can fill in some of the blanks there. You not the answer, but maybe towards the answer. I've had similar experience to you and that i've worked and lived in multiple different systems.

I don't if you know, but i'm majority. I was born in newcastle, what you know you know I am was born in newcastle upon time, but only spent six months there of my life. But the reason I was born there is my dad was working there as a doctor, so born there for that on.

And then they moved to the U. A. You black male inie, no, yes, I was, especially in the year days, but that was a long time ago, so haven't kept up now.

My real bedford van, obviously. So i've had this vision. I am urgently okay. So we we are grow in dubai, which has a kind of a more us style hole system, at least for the experts.

And then I my family moved in new zealand, so I did at school and did all my training stuff in new zealand, which has a more N H S like health system. And as part of my training ended up in houston for a bit as well. So I worked in the U.

S. Health care system for a year. And while I was there, I had this kind of daring change between N.

H. S. Like health care and more capitalist, free market type health care.

And I got confronted by some of my prequel, cy ve notions, you know, by some of my colleagues saying, why do you why do you really think health guys are right? Like why and why is that more of a right than, say, housing or or food? You don't expect free food all the time.

You don't expect free housing. Why do you expect free health care? You know, in from their mindset, that was just an nhs thing. The reality is though that health care is different than those things.

And I know we we've both spend some time and with coin circles, with librarians and everyone talks about in amErica about freedom of speech. Their nh is freedom of speech. That's the topic that they think is sacred and cannot be touched in the U.

K. Health care is a similar topic, and the reality is that they're both quite important. So I often use this example with more my more librarian colleagues. If your five year old son, daughter, lua, and he had to sacrifice your freedom of speech to enable them access to health care, would you do IT? And the answer is, yes, they would do IT. So does that mean access to healthcare is more important than freedom of speech? And often when you confront them with that, they kind of stand back and they go, maybe health care a bit more important than some of the other .

things that we think is alizad cultural things in history important with guns in the U. S. Because I was like, uh, vast amendments, uh, free speed, super bolden and the second endpoint protects us.

But and then like what your gun, as I know it's like in the U. K. I do not want guns at all.

If there's a reference among guns, IT would get destroyed. I don't think think one percent of people would vote for. We have culturally made that decision yeah and and it's yes is pretty much a unit or opinion.

The U. S. Is more contentious. But but culturally and historical, they choose have guns. We've chose, we've chosen have a national health service. If there was a way to get rid of of IT wouldn't be uh universal. But I still think most people would vote to keep IT, but that's changing yeah and I just think sometimes this kind of imposition of the way we've chose structure our country should be, have you to structure your country yeah.

And there is, I mean, I think beyond that, there is a middle ground there yeah, both in terms of health care systems and the gun issue and all sorts issues. I think if you look around the world, there are plenty of examples of where a sort of a hybrid system where you leverage the benefits of both free market health care and socialized medicine actually gives you the best outcome is the most efficient outcome, and he gives you the best results.

And so regardless of your uh you know base cultural reviews in each individual society, if you look at things from a more divisional perspective, what will give you the most bank for buck? What will give you the best population outcomes for the money? And the answer that question is reasonably clear.

If you compare different countries, we're lucky in this part of the world. We're in australia. We're in sydney right now.

Uh, we have a hybrid system. So we don't have an american system and we don't have an H S system. We have a fifty fifty system roughly.

So fifty percent of the population in australia is insured and fifty percent are not. The insurance schemes are partly government subsidies. So the government does have some measure of controls on a pure free market system.

And as a result of that, when you look at the percentage of GDP that australia spends on health care is lower than both the N. H. S.

And, uh, the U. S. Health are system. But when you look at outcomes, things like infant mortality, cancer mortality, just overall population age, what age do australians die? We achieve Better outcomes.

So Better outcomes for less money.

for less money. Now how does that work and why does that work? And I think that's really the question that should be explored a bit more and thoughts on that.

But can we go back a step? Firstly, just let people know the error of medicine news ork. So people listened. I kind of you do.

Yes, i'm a surgeon. I basically these days only do below caner gery. I'm very involved advanced bell cancer specifically. And I trained for many years.

And that part of the reason I went to houston is I wanted to work in what would be regarded as one of the best cancer hospitals in the world, which is in the under seven houston. So I went there for a year to get additional experience and come back to australia with that. So basically about cancer surgeon, or more formally known as .

a calorically surgeon and and working as a surgeon, are are you exposed the entirety of how the healthcare system works? And is this something you in your colleagues discuss?

yes. Um not really. Is the is the answer that question? I am exposed to a the weaknesses. So we've all noticed and me, my colleagues and I often discuss how bed pressures are getting worse, waiting less are getting worse.

And that's a fairly pervasive problem across all specialties, including the sharpen that is take literally, which is cancer surgery. We still feel those pressures and increasingly so. And I think um that's the element we discuss.

We do sometimes touch on comparing health systems, particular australian, new zealand because we are a shared college of surgeons. So we most of our colleagues in new zealand are part of the same fraternity that we are. And so and there are significant differences in the way healthcare is delivered in terms of funding so that we talk about frequently.

okay. So with the exposure to all the health systems, you seen this maybe an unfair question, but which do you think is, uh, a more broken system, the U S. System of the british system do you think is worth as uh, free market but actually I don't even believe that he is free market, but as another point, yeah uh as a beauty capital system uh or do you think is worse as a beauty .

social lizer so worse overall yeah I ve ve ve had to choose yeah yes, I would choose the N H. S. But that is because, uh, I tend to as a medical person, I tend to want maxim benefits from maximum people OK. But where and you get the highest quality health care, that's the U S. So so but for a select people, yes, that's that's the problem.

And so is IT like anything which is capital. The riches are the Better access to care you have is like if you if your rich can N A T O, that's exactly right. And there is is .

a bit more plica than obvious ly in the U S. There's actually a middle class that's probably more negatively affected than either end because there is a safety net for people who are I don't have the means but have enough capacity to ask for help, uh, which is a another common problem in the U. S.

Where if you don't have the capacity to fell out a form, you you're really left out and in the dust. And I think that's a bit of a problem there. The middle class who don't get covered by medicaid but can't afford high quality health insurance.

They are the ones that you often hear, you know, horror stories about losing their house and going bankrupt. There is no safety nets for middle class. The forgotten middle class, burning standards and others always talk about. So that's really the population is most negatively affected by their sort of jewel health system that they have got, where they've got medicated for the very poor and they've really high quality health care .

for those that can afford IT. O okay. And just on the U S system, um there there is a lot of complaints about the Price of drugs in amErica which are considerably cheap or across the board in places like canada and mexico. Um is that a problem of essentially corruption and Price fixing or is IT something else?

It's a problem where the incentives are not aligned between the free market and the good of the population. And that's something a theme that you will see recurrent in this discussion, where if you leave something as fundamental as health care to pure free market a dynamics, then you will have to sacrifice things like that. Because if you've got a really important drug that you know is very desirable, you can charge whatever you like.

And you know this this reminds me actually just as a slight segway, you once asked one of your um one one of your I guess the question and and IT was related to a fiascos happened with in the cypher currency world. And you asked that person who was a high power? C E, O.

is what you did, ethical? Mi.

that's right. And that really stuck out for me. I'll never forget that because he was confused by that question, because it's not the world he deals in. You people who are in finance and in safer example, sea of a drug company, they don't necessarily deal in that world. The world deal in is profits regulation, law.

How much can I do that's legal, that's regulated that I can get away with for the benefit of my shareholders, right? That is the pressure they face. There are not doctors, there are not nurses. There is no code that determines what you do beyond your obligations to your employer and to your shareholders, right? And so when the incentives are not lined, bad stuff can happen.

Well, look, if you if you are a shareholder, if you are sorry, if you are, see of a large form of the company and your goal is to drive up the share Price, you need to have either more expensive drugs, solve, solve medical issues that need fixing, or how people nica well.

yes. So there are perverse incentives yeah essentially and there are and so and you you're talking about, you know, mega corpse with thousands of employees and right. And so IT is IT is IT unforeseeable that if the incentives are perverse, that you wouldn't have issues like this.

I mean, the reality is that what happens now I do draw the line a bit when some commentators will say, you know the entire medical professionals compromised. That is definitely the case. Um there is advertising and there is uh pressure from from advertising and from uh companies that try and swear your view.

But the difference between uh a shareholder or A C E O of a of a drug company versus a medical professional is we have a separate code of conduct that determines what we do, something like the hypocritical, something like the societies and the colleges that police your activity and ensure that you are Operating under ethical standards. And if you don't, there are consequences to that. So we're not immediately as exposed to some of the um perversions that exist, but certainly we we sometimes can be influenced by IT. And I think that's where I kind of differ from some of the previous commentary that i've heard on some of the shows, which suggests that the entire system is corrupted down to the level of the medical professional lot as a medical professional, I guess, on bias. But I disagree with that statement.

I think is potentially more with not surgeons. Doctors we call the GPS of england, whereby in the U. S, they say salesmen, so salesmen will come and knock on their door and same, we got these drugs that do these things, or we've got this version and they try, instance, devise or convent them to sell the drug.

And there's some incentives in there with doctors to prescribe pills. And I think the general complaint is prescribing pills rather than alternatives like exercise exedra. Yes, now IT feels like as a problem, worse, worse. In the U S. There's a big debate in the U K.

At the moment where the debating whether to prescribe OEM ic, but I don't know enough about probably to do with myself, but they are running an actual program I I think is in manchester IT might be manchester where I think they've got a three thousand person test sample and they're going to give them freedom memberships. And so they're actually starting to test alternative things. And so I see things like that happened in the U.

K. But when in the U. S, I hear and commentary the the health systems fact in the perfect incentives, but I don't see change because there seems to be too many people aligned to the best of us are the drunk injury.

And let me saw one. I've always said this when I get to the U. S. And I, you, but the only time I watch T V in the U S. Is sports. So the other morning I get up, uh, it's early in the morning and i'm watching, uh, liverpool play to see the half time, right? These ads, and one in every three ads is a drug at, and I recorded said this, there are advance for drugs, for conditions I didn't even know exist, and yeah, add drugs I didn't even know exist and conditions even know exist, and then have this fast speak inside of warnings. In the end, it's like basically, if you take this, you might do, yeah, yeah I like I think I think a purely free market medical system incentives IT plays on the bad incentence of humans. I completely .

agree with that. And and so therefore, in countries that have generally more robust healthcare outcomes, direct to consumer marketing of drugs like this is prohibited by the government because, you know, it's you. You need an intermediate media there between the drug company and the patients.

You need somebody who has medical knowledge or scientific knowledge that can translate the advert at the ad that they're selling you to what is actually real and not real based on the available scientific evidence and based on your uh, experience as a medical professional, if you allow drug companies to sell directly to patients, while that might be considered freedom of speech or freedom of capitalism, in the case of the U. S, if IT result in negative outcomes, then the society as a whole has to decide as IT worth IT. It's a similar with the gun argument.

You know, there is such a thing as freedom of speech, freedom of an advertising, freedom of drunk companies to do whatever they like. Up to a point, when IT starts to have negative societal consequences, then the society has to decide, is this what they really want? And again, I go back to this argument.

There is a healthy baLance between one extreme and the other. You know, you cannot have a drug company in any way viable in your society because they serve a reasonable purpose. But the same time, giving them free rain to do what like is also probably in our appropriate. So somewhere in between those two extremes as where literally where the money is in terms of getting Better outcomes for your population yeah like I see things. As you know, baLance is usually best when IT comes to questions like this.

That's what I quite like. So we have noise in the U. K. The national institutes and and look is is chAllenging because they approve disapprove certain drugs and then some people sue the government to make that track available.

Yeah might be just because have to work to a budget yes, that's the thing. And I just has to work to a budget, but I feel like that also creates a discipline. Um I also don't feel like doctors can be cuy of salesman visit doctors in the U K. I don't know what you know.

I'm not sure about the U K. Um there are very strict rules in australian new zalm. So you know sales people can visit with permission of, say, the provider, the hospital and is very strict limitations what they can provide um and certainly they can h advertise their product directly, right? So in hospitals in australia, you will never see a drug company add placed in a place where you can doctors can be influenced by IT. Uh, with exceptions. You know, sometimes things gets snuck inadvertently, but that's not generally considered Normal or the right thing to do.

Is there A A kind of, is they like a job? Are they like two different sorts of medicine that this this falls under? For example, I can no fan, I can go one by pretty short neuf an advertise yeah um you so they just classify differently with over the counter allowed to advertise what is the kind of medical what over the counter ah what makes .

the the individual country decides. But in general there are rules on what is a prescription medication and what is an over the counter medication. And that changes with time. So very recently, for example, and where I live, they're really classified drugs for you, tract infections as being able to be dispensed by pharmacies. okay.

And the reason for that, despite the fact that generally was priority recently, IT had to be prescribe by a doctor, is IT was a high burden on the G. P. System, where patients would come in for very simple utilize, and that would take up a GPS law unnecessarily. So the government decided fairly sensibly to go we should probably shift some of this burden away from the gp so they can see more high intensity presentations.

Can you bring that back up? Just Denny.

one thing I will say, you know, you don't want to crap on the U. S. System too much. One thing about the U. S. System that I do like when he comes to advertising is any payment that's made by any drug company or device manufacturer to a doctor is declared on something called the open payments database. The reason I want to mention that is any person can go on the open payment database, search the name of their doctor and they will tell them exactly .

how much money they well .

it's really it's pretty shocking when you read IT ah but we don't have that here. So what you .

shocking see the payments every yes.

sometimes it's astronomically high and sometimes it's for research things, but at other times it's just like a direct on a araria kind of payment o so here.

U.

K, it's publicly over there. Okay.

for the list people listening. U. K, to offer weight, lost jobs to unemployed with weight issues in economy is, yes, so this is an interesting that so prescribing weight lost jobs to obese and employing in the U.

K. Could not least economic potential of the fat men in europe. The hell minister blazer in the welfare U. K. Health security was treating as a vel plans to give weight loss job to unemployable diagnoses be a no base. Uh, so that's an interesting because the power debate is the department for work compensations be involved in health care.

I would say A, T.

but this is where IT is.

D, W.

P, essentially the ones driving this because they want to reduce the burden of people, can't work. I just, I just flip. The only word flip is offer people account down on their, on their welcome.

yeah. I mean, more importantly, maybe we should work out why the obesity rate suddenly shot up in the early one hundred and seventies when I was fine for decades before that. I think that's a bigger question.

If I knew, why are people solve? Is like, what is the reason for that? Is IT reversible? Tell me.

well, I mention classes obese.

Well, I think that is reversible. And I think um you know i'm not sure I realized we're trying to be a bit more broad and our discussions here. But in the early one hundred and seventy, something changed.

And if you go to the website, we all double the fuck happened yeah yeah something. If you look at obesity rates in in the U. S, for example, they shot up dramatically after the one thousand nine hundred seventies. And they haven't really come back down. They'll of a stabilize, but they haven't come back down.

I yeah and I guess .

the question is what why is that? Is that the low time preference high time preference thing is IT something to do with um you know let's sell as much high calorie cheap food ds as possible? And and are we sort of in incentivize to consume that above everything else? Uh, it's probably something to do with that. And given in such a recent phenomenon, i'm sure IT is reversible if we think about IT a bit harder.

Look, tell people what the fuck happened to because the people listen to this. You haven't listen to the eight hundred other shows we made big.

yeah. So I guess my interest here in the reason I got to introduced to you guys really is what is that about our healthcare funding that's driving all these negative consequences? So one of the things about obesity is that, uh you know you can see that they are now prior to the nineteen seventies, the obesity ate was always roughly between ten and percent .

I made but is tighter than that. It's like, yes, for one thousand and sixty to nineteen eighties over twenty year period it's between that looks them to me between about thirteen and fifteen just two yeah two percent point indifference yes and then from eighty to ninety four we shoot up to like what? Twenty four percent twenty three and half yeah .

unfortunately you know, even though twenty seventy, twenty eighteen got about forty percent, we're sitting at about that now. So IT has a lot of play told that level at twenty percent. So about just about forty percent yeah, like today yeah, yeah, yeah.

But that that is for essentially thirty percent in one thousand hundred and sixty years to forty three, forty four percent. So really they change is we call IT more with the I well.

this this is just obesity. So this this would be above thirty.

yeah. So severely ABS was a one percent under one percent in one thousand hundred and sixty. So essentially the the civilian obese is nearly reached the rate. What the obese one o now i'm .

looking to blame seat or anything like that is not my argument. My argument really is that um we used to have low time preference because our money worked and IT made IT incentivize us to save and think long term. And one of the issues we have today is that we don't think long term, we think very short term and that creates all sorts of negative consequences.

You know you're more likely to drink, you're more likely to smoke, you're more likely to eat unhealthfulness, you're more likely to gamble, you're to have all sorts of disorders as a result of the fact that a lot of people are disillusion with their own future. You know you don't know what you're in. You're twenty, you don't really know what your lives getting black when you're forty and fifty.

That's a relatively new thing. I don't think IT was the same in our parents generation. You know they despite the fact that that have had a harder life, they had a bit more trust in the fact that their future was secure than we do today. And I wonder, where is that sort of societal consequence, result in weird spin off side effects like this, where we eat unhealthy fully and we get fat?

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The science they understand if they puts you certain ingredients into certain foods. IT gets us, they know if they puts salt, we need to drink. You know, theyve just got hook to ship food and then it's like is available everywhere.

You know, you can go to mcDonald and get a meal cheaper than you can buy a vegetables and supermarket. Pu, and the mcDonald, ah I just think it's I think that we just had this whole society shift where everything is like easy and available for all of us. yes. And and that's happened at the same time where people have to work more. You know what one salary you fight to now, boy.

yes.

this part to look at home. Yeah I mean, look, I mean, i'm i'm yeah single dad. And after a day's work, being motivated and able to cook a good meal with my kids was hard.

I tried IT. That's plenty times where we would like take away. When I was a kid was rare. I was as a treat yeah like once a month could have done twice, twice a week.

Sometimes all we go to the pop and get up like that feels slightly Better as a cooked meal. But but it's just like cultural shift weren. Everything's just been made too fuck and easy.

I am that well, except for the working environment that's been pointed out. So both parents generally have have to work, just make ends meet and and access to high calorie foods is very easy. And that's also a recipe for what the graph that you're saying here.

But I have to say, you know, I don't think that necessarily was the case in the seventies and the eighties. So it's been a gradual change. But IT takes time for uh, obesity to find its way into this chart like this is this is a lifetime worth of effect. It's not like it's not like you wake up at five in your obese, generally speaking, is a bit of a lag piece.

We have not picked well.

we may have peaked around now, I would say because that seems like the figures are not getting a lot worse, which is a good thing. OK gives us hope for the future. And I don't think that's the effect of exempt or bariatric survey, which is wait surgery.

I think that's the effect of IT doesn't get much worse than this is pretty hard to have over forty percent your population obese. So hopefully most of us are thinking that we can reverse some of y's trends with time. And I think you know like IT or not, I think sound money is part of the solution, if not a big part of the solution.

Yeah, it's funny. But I the reason I I think some money is part the solution isn't because I think the system has become just corrupted by by money. And if we have saw money, these companies won't exist.

I think I think someone is in a window into a world what we ve ignored, into a world of discipline in long term inking, long term thinking 啊啊啊 morality。 Yes, I mean, let's be onest. There's some this ship that goes into these pesticides and herbicides. It's not good.

And we talk a bit of about healthcare funding in general and how that relates to that. So one of the things I mentioned in the bit life talk and that I opened mice a bit, was the way healthcare funding IT has nothing to do with health care Price. So the way we determine healthcare funding has nothing to do with health care Price, and i'll qualify that.

So I don't even remember but yet pressed and push on here yeah he showed this chart of a of uh the american bureau's labor statistics showed the Prices of goods and services with time and the different inflation rates of the different goods and services and the time you guys focused on the difference between CPI and house Prices. And if you can bring that chart up, but you sort of didn't gloss over what the highest ticket item on that chart was, which was hospital services. So there is this graph which shows inflation and cost of things CPI.

Someone in middle, that is a blended average of everything. You know, cars and things are down the bottom. Two, look at higher, yes, right? That that chart. And then you've got housing, which is pretty up there because, you know housing the scarce, I said, I guess, but the number one item, the one that went in Price the fastest over the last since nineties of anyone is hospital services.

Now the point is that me and say hospital health, yeah yeah.

just know hospital beds and know just going to hospital for for whatever treatment that you need OK, which includes medication costs, anything else that you get in hospital so in the the question is why is that? Why why is the inflation in Price of hospital services? I think there's one with um the the the press impression with the multiple graphs.

Ah yes, the one where is kind of like the red lines, read the top of the blue lines at the bottom. Um if you have actually .

go on my laptop.

you um if you going to ask ask good yeah first day ask a bad GPT effectively IT goes up a health care.

a costs around the world, particularly in developed world. They go up in Price about ten percent a year OK. So it's one of the fastest inflated Prices of of anything any good or service.

okay. And in press and start that he showed IT is the highest go, fastest growing. That's the one there. So that's I told twenty seventeen .

s so so just so good people listen to so this is a Price changes. Uh just ninety nine thousand, seventy thousand seventeen showing like Price inflation so down the bottle of its TV, which are become much more affordable toys, more affordable software. So it's a bit like people and when you go to buy T V now the T V, that by now for five thousand in like five years you get up for a thousand. And so in cars are about in the middle. And then things i've gone up in Prices, food and beverage, housing, wages, medical care services code, hospital, medical care services.

hospital. So one is impatient so or .

GPS and things .

like so overall .

inflation at fifty five point six percent, uh medical care service is looks like is about one hundred person.

Hospital services like two hundred percent is at two hundred and this is still twenty seventeen. There's one that goes to twenty twenty four and that Spikes even faster. And towards the end because of covered and other things 是 okay。 So there's it's gotten worse since now. The issue with that is how do we determine increased healthcare expenditure? And that's constant nhs, the us, australian, new zealand.

But this is an increase ed in total spend. This is the cost of the service itself rect like for like Price.

Yeah yeah. Where the what we spend on health care was about two to three percent a year. So the N.

H. S. Funding goes up two to three percent year. Australian health care funding, the amount of money the government budgets per year, in addition to the last year is two to three percent.

So this is why we got bigger, waited less.

correct? Because the funding is not in any way keeping up with the Price. So if you spend two to three percent year extra health care, but the Price has gone up ten to twenty percent a year, you can expect worse outcomes right now.

If you look at the number of hospital beds as just as one measurement number of hospital beds per capital across any country, let's take australia for example. It's a straight line down. The number of hospital beds per ahead of population is a straight line down.

Sine since is total and proportional down total, but number ers total.

But numbers are going up very slowly, but not the populations. Yeah, that's right. So OK, and it's because the cost of a hospital bed is high and it's increasing rapidly. And so the additional funding we're getting, government funding and other sources has no hope of keeping up with that. And so you'll get less for your dollar with every passing year.

if that makes sense. But why has IT .

been so much? Why why is this the .

that's that's a good question. Thousand um china looks like the other one is gone up yeah um but is in the what's the purple one? Germany everything is kind of calm down you know weed is like the china chat is almost verse to the the rest of the western countries.

Yeah well, different pressures. Now the other thing to mention here is is not just the number of population. The population is older and sicker in two thousand eighteen, and he was in one thousand nine hundred and sixty.

And is that right? So each individuals you need, we need more beds anyway, even if the population stayed constant, right? So what you're getting is less beds per capital.

You're getting less drugs for your dollar. You're getting less Operations for your dollar. Now that what that translates to is longer elective surgical waiting times in australia with a real problem with hospital ramping.

So this is what the ambuLance literally over the patient, so they just cut out. We have the U. K. yeah. So all these things are all worsening with time because of the fundamental fact that health care inflation is running at ten to twenty percent per year, but health care funding is running in a two to three percent per year. Now why is health care inflation running a ten to twenty percent year?

Yeah, I was the question big. Well.

it's a scarce or asset than housing. It's a harder money than housing if you want to look at IT that way. So i'll qualify that IT is easier to build a house than IT is to build a small hospital and IT.

IT is easier to add apartment beds, and IT is to add hospital beds, because hospital beds are harder to make more of, because a hospital bed is a fairly high tech bed, so a hospital bed requires oxygen delivery, IT requires expensive monitoring equipment, and IT requires staff. You have to pay a nurse of salary to staff. A hospital bit is not just a box like an apartment bed would be. And so because it's harder to make, in other words, a scarce asset, a scarce ser resource, Price goes up faster. It's really that simple.

But there's such a range of costs that go into hospital services, right? Is great. Is people .

i'm just using bees and .

yeah but i'm just thinking if people it's infrastructure, it's because I there was a child I once saw that showed the uh the changing the number of uh middle management staff for hospital. This is the uh number of uh, new clinical. yes.

And there was see if you can find that one. And the collision growth was minal. There was a huge growth yeah in back off his staff yeah so that is a response .

to not understanding what the problem is. So you know when the reason the manager, erik class, and hospital grew so quickly is because they're trying to fix this problem, but they are not really doing that. They don't understand the source of the problem.

yeah. So they just go, why is ramping bad? How come the hospital is are not keeping up, have got more beds this year than last year? IT must be a management problem. Let's get more managers in to sort this out to try and get more for less. That that was the idea behind what they call managed care. So at at a certain time, mainly in the nineties and other two thousands, there was this flip from let's hire more front line staff, so let's hire more administrative staff to try and sort out the problem. And and the the issue with that is that you know, having a managers all well and good, but having twenty managers doing the job .

of one doesn't fix the problem is twenty twenty two road is hired by job category nurse in thirty thousand administrative eight thousand six hundred clinical assistance which countries? Yeah this wasn't the chart that I was .

thinking of daily. There's a graph that show yeah growth of add versus front line staff. And yes, I mean, we've all noticed that uh, in our daily lives that there is there's almost some hospitals have an entire separate building that is just administrative .

separate to the hospital. Could administrative be a lot smaller? Is that a no question? K so where are they wasting? Where is the wasting?

It's the same as any kind of big and I this is mainly in government uh, funded institutions. Usually private health care systems have way less admin. The front line staff OK because like a business yeah ah the problem with any sort of a large government institution is there is this inherent bloat with time procreated.

That's correct. And so that's that's generally what happened. So and they get busy with various yes, these charts insane .

anyone listening we've got a health are administrators far outpace physicians and growth charts and .

look at where starts you that's .

already just starts in nineteen seventy five and they look like both about the same where I mean, it's it's like much marginally above the line. Let's let let's say that's fifty fifty percent right over nineteen seventy five to two thousand and ten physician growth is what was a percent two two, one hundred .

percent growth maybe that and then a admin .

growth has for nineteen seventy five to two thousand ten about three thousand two hundred and fifty percent .

minister probably A U S. chart. Um and so you would find probably that physician growth isn't really keeping up with population growth necessarily from and so that is a more natural chart. That's the it's the purple one that's completely unnatural.

Yeah is is interesting also that they've got this. They've log on the one thousand nine hundred eighty two perspective payment system, drgs.

and so that we have that in australia. So D, R, G, I kind of like units of work. So you get paid. There's a sort of measurement of how much work output you are expected to have, and you get paid a in relation to that.

Yes, complicated. But but so what there are other things are on my mind is like the health, the health care options. The system office was very different in one thousand nine hundred and seventy five. I don't think people will go into the N H can and asking to get breast for amenity, which is the thing that you can get if you depress. I don't think they were dealing with the same level of mental health issues.

Um I know when speaking somebody I know IT what's in the um a hospital in bedford while I live and they say people are now treating uh hospital and like a doctor surgery and they've got sure I I think because I have S V S I I 没 and i've been and i'm there for four hours， five hours. I've a number blood test, have an E, C, G, and then I go home, but they said they didn't. Insane level of this stuff. yes. And so I think obviously, part of the change has probably been the change of medical services provided potentially.

I mean, this this is certainly more demand on resource because, uh, you know, we understand more about medicine and so and there are more conditions to treat and the populations getting sicker in general as well as older in western countries. So there are certainly more demand.

But I have to say, didn't sick a calls they get in an older is in an age thing or we just get in sicker .

an age and things like ability which which which definitely increase your uh you know your risk of other problems that require hospital services OK. And if you require a standard problem that's not related to obesity, like let's say, you have a honest repair or something, if you're obese, you are going to be in hospital longer and your complication rate for the wound that you have is higher.

And so you require more hospital, even need a big bed that cost. Potentially, we have some of that too. So there's definitely more demand from that side of things.

However, I will say that in general, things should be deflationary, right? Think about this. So as we improve our our technology, we should be able to do things more cheaply. And there are plenty of examples of that idea with a lot about cancer.

Even just in the last ten years, we've gone from most bell cancer being treated a surgery to in certain types of bell cancer, only half paid of the page requires because we can provide outpatient treatment with medication that fixes IT so longer in Operation. So in general, IT works both ways. As as health care advances, we shouldn't necessarily expect to everything to cost more because we could probably treat a lot of things a lot more simply with increased knowledge, gy and technology.

So I I don't think the advancement of health care necessarily result in in additional cost. What I think results in additional cost is the fact that, uh, health care compared to other things like food and housing and whatever you want, is generally a more scarce asset. And so diluting the money supply results in quicker inflation in that asset or in that service.

wow. And that to me, that is the single biggest ticket item here. It's not so much in the aging population. It's not so much other aspects of inflation. IT is simply that aspect.

Have you have you been intended to your colleagues or well, you fix I have been is IT resonating? Well, it's interesting to say that.

yes, a certainly, we're in the early adoption phase of that, I would say. And we do have a you'll be happy to hear this, but there's an australian facebook group called doctors into bitcoin love that has about two thousand members and what yes, pretty significant. Now there's a lot of poor coining that goes on as well.

Yeah, but there is A A fundamental .

understanding in that group of people that bitcoin does fix this element of the problem increasingly.

So danny, you bring back that tweet from my area. I want to say just blue. My mind is, is so fascinating. You never want to mean with the child, right? So I at this out, this is what Young as china is about, what Young people, I think Young people care about. The topics are most important thing right now, okay? And it's gona fascinate you and the things they least care about, okay, so yeah, so look at what is the top issue.

inflation. Yeah, which sort of .

expected isn't .

yeah now going look at the world currency.

So the the the thing that most interested in is inflation because I think, yeah, this is my point. I keep making every article called the cost of government because i'm trying to end like why the fuck we so far? Why do we keep voting for people over over again? Why do? Why do we have one ship party and then we accept another ship party? But where's the revolution? Where's everyone say, look, enough is enough here.

And I, like, I did research. I, what do people care about most? And IT basically is money related.

Yes, inflation.

which is biggest, most import issue, is inflation. That is the impact of my money inflation, making me poor. A second one is jobs.

Because whether is your own job or the jobs in the wider economy, you know that good for the economy, you know good economy is good for you? yes. okay.

The economy itself is the third thing they care about. The next thing is corruption when money is getting stalled. funny. okay. So if you look, basically, the majority thinks people care about our money.

okay? And I think right now, where a timer everyone knows, again fucked yeah fuck with inflation, get lie to yeah, we have a solution here. But we've done a terrible job attesting .

that story to people. That's exactly right. terrible. And I think outside of these bubbles and the vast majority people still believe inflation is Normal and .

necessary and is just part of.

yes, I remember being like, I think, yeah, hopefully more and more people slowly understand that. That is not necessarily the case. And I think this is the job of these these types of discussions.

I mean, and hopefully few thousand people see this. And the point is to try to educate people that the source of all the problems are worried about in the top of the charts. One potential solution you're ignoring and it's at the bottle of the now the wording might be have an effect there as well. You know maybe crypt to currency as a whole may not be the solution, so that might be an issue there as well. But in general, I think the the education has not made IT to the main instream at as far as the connection between something like health care inflation and bitcoin that hasn't really quite made IT into the .

general lexicon of most people's knowledge. Well this is one of the ways the we made IT hundred sixty shows and there's very good people out there who go uh had pot is already going to create new podcast and they're going to do that good job. But we are what we're doing is every four years we are recruiting a bunch of people into into a uh into a coal and then will sing around penny channel.

That good is a bit going great fix. And like we gotten, get out, get out, get out there. And I can tell people so by removing biton from the podcast and allows me to have this conversation is like, I don't know what this why the health care system is fuck whatever health are inflation is is killing you, killing you something like that and then you're going to, oh yeah, that's with the money the money tell if the .

other angle networks is when you ask, like when to ask other clinicians or even uh and I tried to get them to understand, you know, why is IT that in our society? Uh, you know, are the percentage of GDP that your government spends goes towards things that you don't necessary agree with? So if he asked the average australian citizen.

we just had this come to say what sorry, what cover of your name, your. And that's a dog. Um so interestingly, we will have this conversation we have Michael one with and so even a conversation I was like something need to fucking and change and there's a couple of I have like these radical ideas i'd like to be tested.

Like for example, when you have an election is done based on a manifesto promise, you have a manifesto, i'm going to do this. I'm going to do that. I'm like, fuck this.

When we have an election, you put your budget in, you gonna set your tacks and you spend rates. And then I want to see a fucking in chart. Yeah, I want to see conservative next to labor, next to Green, next little, both based on, yeah.

And you know, I think people are smart enough to get. I'm not just gonna with the one who has the lowest tax because actually I also see the other things you're gonna do to to you know cost the budget. They're gone out.

I don't know. Give me to help care. Give me. And so like, I think people are smart enough, but I think you should do IT and I think they have keep that budget IT would make sense yeah.

And if they can't keep to that budget and they have to borrow money to put in dead, I think we as a country, we should get to vote in or new election, direct democracy because we've just had IT now fucking labor coming, and they just, they made all these promises on taxes, and they are fucking lie to us. Yeah, they change. yes.

Same bushy. So many way I brought this up, i'm ran in the way. Jog over. There is like, I think on our tax forms, he said I think he was discussing his glory end that we should be able to vote where I wall my taxes, go to that when money goes.

Now that will never happen.

But you know.

you have to ask yourself the question, if you give the average us. Taxpayer, and you show them whether tax money is going, many of them would probably reallotted safer. Example, some of the defense spending towards health care or something.

Course right? The problem with why that will never happen is because the defense spending is part of this money printer fly. We'll think they've got going on where they can print money and have its back to weapons manufacturers.

And there's this infinite loop. Well, you have to understand the way they convinced themselves of this. They think it's good for the economy. Whatever is there are always where they convince themselves that they are doing the right thing by the people by doing this infinite defense spending fly world. Just as an exam, health care doesn't work like that.

If you start diverting someone that funding towards towards health care, you won't necessarily see that back in terms of me know buying things from companies, not necessarily. And so they have these other pressures, whether you know prioritizing certain spending towards areas that they believe are Better for their economy at the expense of the health of their own population, just as an example. Yeah and so i'm not sure you'll get a situation where the different parties will say, you know um here is a smaller st board of things.

Which ones would you like us to pay for because they think they know Better than you. And so i'm not sure you'll necessarily ever get that there's also this league like there's the container or on effect leak ride. So the money starts up the top and then there's always rent seekers that pill for the money and by the time gets to essential workers, essential services, half of its gone, you know?

And this is the other angle that works, as you know, I often will say to a nurse, for example, do you think it's Normal that you know what all do respect to, say, real estate agents? Do you think it's Normal that real estate agents make way more money than you in australia? They're not qualified.

So why? I made a film about inflation in U. K. And we went to a, we went to a food back, and there was a nice there. Yes, I made me so big that you made me angry.

SHE is nurse, and he went through the cover and all that, you know, on the pressure around that, you know, ah he did years of my nurses have to train fucking hard. I think I think possibly the most underpaid industry. I think I the nursing .

and in my opinion nursing and teachers are the two most undervalued professionals because they are fundamentally important to the functioning of a society. right? Yeah, but they're not value in that way.

You can take teaching home and itself. You can like a bit up and treat myself. But but no, I mean, how many years? And I spend twenty four to five and they have work a high pressure front line job as well on their feet.

And he has to go to a food bank. sure. That's a fucking that's a shame on our country.

I I agree with that and that's the case in most developed countries.

Is not just .

your country well there good. And I think um you know we need to value that more just in general.

And do you think there's an imbaLance between how nurses and doctors are both valued and compensated? Because I know look, doctors like have to be superman. Yeah they do what seven years and yeah sensually the junior doctors I know start and lower pay, but most doctors will make good money at some point. Yes, but this seems to be an in baLance between .

how both are valued. Yeah I mean, IT depends on how you see what's called the consultant, right? So that's the when you finish train and you become a surgeon, uh IT depends on whether you think i'm worth more than say, the C O of a um account acy firm on my worth more than that person say .

my life yeah right.

So so you know IT depends on that. The level of responsibility lie is the other thing you get paid for. So know if if a patient dies on the ward, generally speaking, the buck stops with the consult, whether it's a physician or a surgeon.

But yes, in general, surgeons and doctors make a lot of money. We are relatively well off compared to the rest population, particularly australia. I guess the question is.

is are we worth that or not? Not even question. I'm thinking is that we just on the value and undertake that.

that may well be true. But but I think the main reason for that is there are you know there's probably multiple nurses for each consultant ah. And as we pointed out before, the health care system is just underfunded and has been chonita underfunded every year.

If the health care system was compensated by tax money at the rate of twenty, twenty, twenty percent year, then relatively speaking, nurses sellers would be significantly hard than they are now and they should be significant than they are now. I don't think necessarily our salaries need to be my chair. Um I think we are valued simply because of the amount of responsibility that we have to take on, not so much the hours.

It's more like the buck stops with you and you have to make all the decisions, positive or negative and live with those decisions and to get to the point where you can do that is very difficult. You know, in terms of time spent in hours worked and just stress levels, you know, it's not easy. Becoming a doctor is sexually very difficult in terms of stress levels. And I think our compensation, relatively speaking, comes because of that as a post in the number of hours worked.

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That is river dot com, which is R I V E R dot com. okay. So do you think a return to a sound money standard does fix a lot of these problems?

Well, IT fixes, yes, in in multiple ways. So when we talked about the time preference issue, so I think a healthy society will use less a less health care resources. I think um understanding health care Price inflation Better than we do now ah, we will go a long way towards improving the levels of funding that we get, which we are currently not getting.

Um I think um reducing the amount of leak in the system. So reducing the uh can tailor effect where a lot of the money goes towards places that are just getting preferential benefit just because of their proximity to the money printer. And that includes things like, you know finance types, stock brokers, real ate agents, bankers.

A lot of that money is getting, you know, going in places where I probably shouldn't go. And I think that would help. And then finally, there is this broader issue which you use sometimes touch on as well, which is the global health issue.

Know my obligation is a medical person is not just to the people in my hospital. My obligation is towards the health of society in general, including in countries where don't work. And there is absolutely no question.

And you've gone to argentina, lebanon, you've seen what hyperinflation does the society yes and IT dever states their health care systems you know i'm palestinian. Um i'm not as hard line as some of the other people you may may have had on your show, but there is no question that there are feet related causes of extreme global health disasters. You know what's happening gaza such element right now is .

a global health disaster.

regardless of your politics and views, that I M amount of health care resource that's gonna need to be used over the next few decades to sort out that mess is astronomic.

Yeah so interesting on that one. So obviously is really blow up many hospitals because um there's a severe lack of access. Obviously you be aware to medicines, even like bucking painkillers.

mean some of my colleagues have gone there to as as aid workers yeah and the stories they bring back a horrible, you know, that's unamusing tions. And IT is a global health impact, know a lot of a global health resource that we donate to from other countries. Some of that is going to have to go there. And but the trauma now.

they have to deal with decay decades, IT will be decades of health care.

I said, forget about the politics of the situation, purely for medical perspective, health care perspective.

There's going to how much .

israel spent on that war .

put money in spain? A.

yeah. I mean, on schools? yeah. I mean, yes, exactly.

I guess the question is without going into too much politics and that place being originally from there and hearing the stories, that place will always be a hot bit. It's been a hotbed for thousands of years. It's not a while.

The most recent issues, I guess, might have started one thousand forty eight h the reality is that throughout the ages, you know, going back to B, C, even, uh, that place has always been a hot bit. Whatever the empire of the day happens to be, they want to control that piece of land. And the question is, why is that? And it's pretty simple explanation.

You know, africa basically hangs off asia by the tinny strip dirt, right? And so if whatever, uh you know h emp ire you happen to be, whether before the the the current empire the british were there, before there there was the romans and the ultimate and so on and so forth, and at at every one of those points, a population in that region was being persecuted with the goal of controlling the land, right? And what's happening now, and the reason it's a bit more extreme now in that part of the world at least, is because, you know, money is is cheap and wars a cheap. And so, you know, people are making a lot of money of generating this fly wheel of know, the military industrial complex. So a hashtag make more expensive again to try at least reduce the incentive to continue these perpetual wars.

He's so funny. You can't help. But once you've got IT seen into the matrix of the see .

everything with that.

yeah you you see at all. You just one thing .

we have to watch out for IT is this whole extreme is a mango. You know, I consider myself a bit on maximum st, but I am very cautious about all phones of extremism, because what tends to happen, and what i've observed is like, like extremism begets more extremism. And all that changes is the population being prosecuted.

So is just as an example, you know, the solution to nazism and the horrors of the holocaust is not zonis m and and furthermore, the solution design ism is not islamism, right? Solution to extremism is not extremism. yeah. Okay, rather than extremism in the opposite direction. So you know, if we go forward here, hopefully one of the messages we can give out as medical people and as other people, good people, as if you find yourself in a position where you're inflicting harm on innocence regardless of your ideology. You are another problem regardless of your ideology so just realized .

that and and stop doing IT yeah wow just trying to think I I think just talk in fans I put so okay, so back back to the health care system. So OK, obviously we understand and I agree with you that health are inflation is a problem. Uh, but if you were to design a health are system, now you have full control, what would you do? What are the big? The big change is where? Where do you see stupidity? Like in the U.

K. You get free doctors appointment. And if you don't turn up so big and they have someone like twelve million a year, where is in on and you pay fifty pound for whatever appointment they have .

lesser initially there. Yes, I heard you talk about this before. There is merit and having some sort of talk in payment to stop abuse of the system, right? But big, bigger ticket item. I would design a system where the private and public sectors are complementary and competing against each other OK to keep each other honest. So you don't want too much bloat in the public sector and you don't want too much sort of cruelty or hard lines.

Ss, in the private sector, like the example you gave of the drugs, what you want is two systems that are roughly equal in size that are able to keep each other and check and help each other out as required. So for example, you have a global pandemic like we had everywhere you can flex beds into the private sector, which I think health australia lot, for example, and much many people are, are aware of this. But private hospital beats, you were extremely useful to try and keep the ship .

moving during to private hospitals have a bad issue. And I know that sounds like yeah planning beds is difficult, yes, but do they have do they have their own basic show? Is IT just because it's purely private? They always have enough.

They some do. And in this part of the world where the private sector is large and partially government funded, there are certain bad pressures in certain areas but much less than the public sector because the overall a amount of work is less and because if IT is user pays. And so they're are relatively well funded to compared to the they do.

So if it's if you have a fully private h system, do you think there would be any bet rotich? What do you think a fully free market .

always have enough american people?

I don't know, but we know not .

really a lot of the hospitals, you know you can't get in because you're you to have the right level insurance. So the gatekeeper is the insurance, not the number of beds.

But interesting, I want of my S, V, T episodes in very worry. miami. Danny won't ever. The experience is similar to the U. K.

Took about the same matter time to be seen, the whole experiences for four hours, I bet the same for five hours. Um they prescribed me a couple of tables I to take off, which doesn't happen in the U. K. And they run more tests in the U S. And I asked them why and they said, in case there is um um an incident and we are exposed to litigation and then I got a ability and they they but he was still just as an inefficient yeah I mean the but .

were you i've heard you talk about this bit before, but were you aware of the level of insurance you had?

Have any there you go.

So you had a different experience than someone else in in that part of the world. The system in amErica works really well for the wealthy who have enough level of cover to access the best health .

care in the great hospital is fantastic.

Mean, hospital I work in, there was literally the best hospital i've ever been. IT was unbelievable. The amount of service I could provide for my patients was, I was like a breath fresh air.

There was literally no resource constraints. Private health are, I want to to say now for twenty years yeah and in the U K, in the U K. And it's to get a more expensive.

I first got, I think he was about one hundred twenty pound for me in the we're at least double that now yeah i've had my my grad, me, my son. Since then we've been looking to, well, what's the insurance rate of the U. K.

population? It's only it's about twenty percent. But and is the last thing I get rid, I would get rid of cable T. V. Before I get rid of this.

The last thing if I get rid of, but the point is, is I don't know what the waiting this is for my discovery. Yeah, I have no idea. And i've and I so our hospitals, they are not great.

They shared walls that people are over war. The food in the kitchen are crap. They just feel crap.

Yeah, my mind just got me as private. I got a book within three days. Yes, I had a private room for myself.

I had a nurse looking after like two people. I was one of them. If the care was unbelievable. Yeah.

he was a propose. Yeah I mean private the private sector U K. Is great. However, there's only about twenty percent of the that suit. And yeah ah yeah, it's about twenty percent in in new zalen, it's about thirty percent and in this part of the words about fifty high forties low fifty percent in australia. And so what you want I think if you had your way yeah, is to have a more baLance system where it's not so much leaning in any one direction.

Can you get IT to a point? So see what you're saying is comparable services. Are you basic? And look, one of the things we have to accept is that people with a bit more money, they get to get a Better they get Better medical treatment and they get to drive nicer cars and other big out IT just is the same.

yeah. But if we get the baLance right, forget you, we can raise everybody else is health care. absolutely.

If you get the baLance right in the design of the health care funding, which a lot of places have and a lot places have not, okay, then you get Better outcomes for everyone, including the wealthy and including the not so wealthy, because the systems compliment each other.

So in this part of the world, for example, a lot of us are incentivised to get health insurance because if we don't, we are text sort of ah IT attacks more than the cost of the health insurance. So me sorry. So so the way the health goes more in australia, so there's private in public.

Yes, health insurance is multiple providers all competing for your business. Many what the government says is a we are gone to teach you what's call the medicare levy if you don't get health insurance above a certain salary. So if you've got a certain income per year. If you don't get yourself health insurance, we're going to add a bit of tax to incentivize you to get health insurance. And no, but generally speaking, if your income is above about two to three hundred thousand australian dollars a year, IT makes no sense to not be ensured because you're paying more in tax than the Price of the insurance .

that you get here. That's a high salt.

high salary .

yeah what level salary .

is IT Mandated is not man OK, but it's .

incentivize OK and I .

would say moderately expensive. It's cheaper than new zealand ah because of the size of the system. Yeah but it's probably more expensive than some of an example of so i've got two Young kids. Yeah myself and my wife were all very healthy. We pay about, I think, something like four hundred dollars a month for high top quality hospital cover .

two and a pain two hundred and now for me, my two kids um and and we have the highest care the vitality provide which includes the best cancer cover. Yes, you're immediately to see a consultant within twenty four hours and immediate care, right? Two hundred fifty five months that started like I say, started about hundred and twenty two hundred thirty when I first got IT. But we have and by the way, we use the system, but I don't think for it's a lot, but I think is a huge amount money, huge.

I think lot of DDL to income bracket is not a huge mind of money. But IT takes a lot of pressure of the public sector, a lot of pressure of the public sector, which in new zealand, and for example, is not the case. So in new zealand, the public sector is a bit more stretched because only thirty percent people are insured and there are no real incentives to be insured.

It's one of those things you have to like experiencing the once because I got given my first time right and then used IT yes and then I was like, oh yeah this is one of time four yes OK.

And there is a bit of a cultural barrier er in the U K. As well because the H S. Is so valued that people don't necessarily see private health cover as being you know something that .

important because shift in because you have even hearing me talk about the private doctors, the prior GPS, every single part IT is it's a easy way in because it's fifty pounds from appointment, right? And you know everyone know the compound about the G P. I just get in the next center, fifty thousand in the same day and I think that stones in the kind of condition people this idea actually IT might be worth paying for my yeah.

I think it's it's out there in the lexicon of our world that certain health care systems are performing Better than others. You right? So if you ask the average australian doctor, we'll tell you that they sort of aware of which h health care systems before Better others.

We got a lot of N H S. Doctor's that come here, right? And they tell us what they're experiencing there.

We don't get any really any U. S. Doctors that come here, but a lot of us go to the U.

S. And work there for a period of time. So we get a chance to see how things work in different places. And I can honestly say a baLanced public and private sector gives you the best outcomes for everyone, including those that would be would consider health care luxury.

So what would you say to the the liberty say absolutely not. The entire thing should be free market ah you know I .

think that someone of an extreme view when IT comes to health care, I think when IT comes to something like freedom of speech, they may have more of a point but when IT comes to something like health care where like so is what how does that determine the health care of five year old? That's my question to them. If you're five and you have no parents, what happens? You have to get insurance. So at some point you have to accept social services at some point.

even if it's just for children. Yes, that's but that the whole is is this is one of the area because I am becoming quite liberal and I I want smaller government. I like accession, but I keep running into things like hurdles.

I can't get over them. One of the most social services for kids cannot see how that can be provided privately, maybe charities. But I just this such a demand, yes, I just cannot get over that heard and I D I read the literature, read the arguments over.

and I agree with the idea of you as little tax and as little government as possible, but the idea of having, you know, total free market dynamics, uh, I think we will jeopardize the weakness and society, and I think that is unacceptable to me. So at some point, most humans will realize that there are a percentage of our society that we must look after, and we must look after them through some sort of shared collective agreement.

Through government is probably the best way to do IT. Now the government does not have a habit, like we talked about with the administrative side of health care, of getting bloated. yeah. And so there should be checks and baLances.

And that's why I say, I don't agree with a hundred percent socialized health care system, because when you do that, IT becomes grossly inefficient and IT becomes unacceptable even for the average person. And so what you do need is this, this competing idea between libertinism free markets and socialism and, you know, the government, these ideas are complimentary and competitive. And I think if you go too far in any one direction, and I can only really speak for health care, outcomes get worse. That's just the fact. And i'm i'm not sure why people would find that hard to accept.

Yeah yes, if you put if you encourage more people into having private health care, that would reduce the bloat at the N H S. And drive the efficiency in a percent that we need. So it's a good but when you're trap so here or when you're in the us, e nh said something people look at they think about is IT discussed widely and how they perceived it's .

a very good question um because we're in sort of an angle sex and country mean the king was just run here, walk around.

And if you are by a small.

I was again, I think that's a little bit too far.

I'm interesting .

that i've got U. K. In new zealand, australian citizenship. So the king applies to all three of my. Yes, that is egypt.

I'm not a fan of an idea of having a group of people that are unelected, but somehow that have special status. But that's because of my bias. I understand. But so so regular.

Can I get rest for the fact working? sure. Hopefully maybe the U. K, my man.

yeah. So, uh, yeah. So, um here we see the N H S as a loadable concept, but that has somewhat failed in practice because of the bloat in the public sector. That's how we view IT here OK. And we and that's because we see the doctors escaping and the nurses escaping and they tell us why they my salary is roughly, I don't know, something like twice my my counterpart in the public section, nhs, why is now I don't provide any more service.

So that is they leave in there to come here. Then we are taking the ones from, yes, like with you in that is .

exactly what's happening, you know, not at a massive scale, but that is what's happening in general. And that's the general perception that the system has gotten too bloated and inefficient because it's too public sector heavy, right? That S E E.

Give you another example, one of my college just came back from a very good fellowship in the U. K. And he tells me that a lot of the days the Operating list, the theater doesn't start to like ten m, which is strange to us here, because we started ATM here.

And the reason for that is bureaucratic. So like the doctor's that they're willing to work, but there's all these blow to things that happen around the administrative side. That means that things have slowed down.

So it's hard to get the patient into theatre and initialized for you to actually do your Operation, things like that, inefficiencies. And that's our perception on this this side of the world. The concept, however, is loaded, able.

And not only that, we appreciate that. That was what started at all. That's that's the og from our that's what LED to the head care system here because the bridge brought IT here similar in new zealand. So we understand the history of IT, we understand the laudable idea behind IT and the principles of IT, and we respect those greatly. So i'm time to well, it's time to be take a more baLance approach where you have two competing sectors a little bit more baLance in that way.

See these come under that kind of public private partnerships kind of area. And there's a real distrust of those. And I tell you why there's a distrust.

I mean, you probably no, no. But like there's a couple reasons. Firstly, um they intends to be uh their bodies, their friends get construct yeah just just out our corruption, but it's out on our corruption. It's just consider dentally that may get the jobs. I don't necessarily .

think you have to have a hospital. Let's both public and private at the same time. What i'm saying is two separate sectors, one public, one private.

But we we kind of that don't actually we don't have many fully private hospitals, and I don't know actually the systems are so the party .

house was a bit smaller and the .

amount of work specially as well.

correct. And the amount of work that's being done is, uh, in terms of numbers is a bit less. So here about half the surgeries done in private and have have done in public. And then H S. Is a much heavy school.

I guess all I think of hospitals are these big buildings that do everything right. Where's all my the my private treatments have been specially, specially specialist.

But that's because the private sector in the U. K. Is smaller than here as as a percentile population. So here you will have a very large, like melbourne, sydney, have very big private hospitals that do everything, right? Mercy department that do massive surgery is a fully fledge big hospital that is for insured patients and that is privately funded.

See what you do? I guess what you want is a private system that's completely separate from government.

Yes, yes, I know.

But if you take government money and put IT into private Operations, they look at ways to freeze the incentives and they look at the ways to benefit themselves and and is not truly free market.

not truly your market. But you do need in health care, you do need some level of regulation because of the issues we talked about before. So you can't necessarily have a completely standalone private sector that has no input and no regulation because sometimes what happens there is especially as a particular need in a small niche area.

And the Prices become exorbitant. fair. So yes, there should be free market surgery, free market medicine. There needs to be a certain level of oversight as to how that is conducted and whether they have done by government or another entity for you can debate, but I don't think you can have IT completely rogue because weird stuff can happen when you do that with health care.

There any other big ticket idea you would change?

Um I think the baLance of where the taxpayer money goes needs to change, and I think most citizens would agree with that. And so I think the mismatch between citizens views and where the money actually goes needs to be rejected. And we discuss that.

Um I think there's a little waste as well um within healthy care systems. So I give this example in one of other talks. I did a tex talk while back cool, where I mentioned that, you know, for example, something as simple as wound dressing, like when we do surgery, we get this choice of what wound dressing want to put on.

Now if you look at IT from a scientific perspective, and I do have a scientific side to my life, because I do some research with the wonders, things do nothing. They literally do nothing apart from keep the stuff off your clothes, you know. So there's a practical element to IT, but they don't help the wounds. That's pretty well .

establish I T T T T T not really.

you know. So the determine s of world infection have nothing to do with the type of dressing you choose. It's irrelevant. And that's well established in the scientific literature that the wind dressing does nothing.

The rates of wind infections are determined by the type of surgery of had if you've had contaminated, or surgery is clean surgery, whether you are a smoker or not, whether you are obese or not, whether your diabetic or not. So all these factors related to wound healing and contamination, the topical stuff on the wind is irrelevant and and that's well established. Now there are very expensive dressings and a lot of us use them because we don't know any Better and because we like the look of them. Or we think somehow that some hocus focus reason why IT makes a difference. I think things like that contribute a lot to the healthy .

care spending, but you don't actually get anything .

for your rationalized h but what's required for that is less manager's class and more medical class that is involved in management, which is difficult to achieve. So you need someone like me, for example, or one of my colleagues, to want to look at this and influence the trajectory that hospitals going at, as opposed to getting a non medical manager to decide, what dressing should we buy for this hospital?

Is there a bit of a us? absolutely.

Because, yes, there is and there is a weird power dynamic. Someone's paying your salary, but you know more about the patients.

So you control what happens with the patients, right? Do you have the responsibility for the patients, but someone else is your employer? And that creates a very strange dynamic and hospital where the person taking most of the responsibility for the delivery of the essential service is not necessarily the same person that's in charge of things like funding separate. And so there definitely is that now occasionally, i'll get a fantastic manager who is sensitive and understands all these issues and works with you really well. But that is the exception rather than the rule in most, in most of my experience.

But you can't have very bad surgeons because if again, if you very, what's the kind of the equivalent here, if you know, like medical malpractice.

So we have that here. So you there's two avenues in this country. There is the lawsuit avenue and there's the medical complaints avenue. Yeah somewhere like new zealand does not have a lower at avenue. They just have a medical complaints avenue, for example, because they have this thinking, a no fault system there.

So if you make a mistake where you cause harm, and that includes things like car accidents and all sorts of things, they have this thing called a nawfal system, where the government takes you on and gives you whatever you need as the recipient of the, of the, whatever bad thing happened is part of an accident. And that includes things like surgery, medicine. So in other words.

patients don't do.

but you get struck off. You go through something called the health and disability commission, which assess your performance.

and go you are not fit the very rare yeah because it's important you got ta have people the right standard, the highest standard quality experience yeah well.

by the time you get spat out the other end through all the training, usually you know usually ninety nine percent, the time you are safe and competence always we don't make IT.

Guess what? I'm gonna. Should we be doing the same with people within the managerial class of this? Ideally.

but how do you measure performance? That's that's one of the issues is no patient outcomes are not directly related to who the managers, the direction, the medical teams and this nursing team is. So how do you measure performance? The only way they measure performance is budget.

Have I am I in the red or am I in the back? So so and that's not a good measure, but of performance in this field, right? So it's a divulged problem.

Yeah yeah. I just feels like it's such an important relative like and my foobar club, my manager have to a really, really close relation, but we we have complete separation of duties. He's on the pitch ARM off the pitch and we've kind of a line in the goal. But how we get there, this conflict, we we have to have a very good relation should to figure this out. I'm guessing you really need a relationship with these people to figure do.

And it's hard to get because of some such different worlds. And again, the power dynamic is a very strange because could one group is controls the purse and the other group is directly for the outcome?

Could consultants become?

Yes, yes. And the rare and IT does happen, but it's it's actually quite difficult and IT takes a certain kind of person to be able to across both boundaries. So for example, I I like crossing the boundaries between medicine and research and science.

Yeah, I don't like crossing the boundary between medicine administration because I don't see myself as a good administrator. The type of surgeon is a good administrator is a particularly unique type of individual typically. And it's actually very difficult to be good at both because there's such different worlds.

You so yeah, it's that part of IT. I don't have a good answer for I should tell you. However, I think if you design a healthy system, a lot of these things take care themselves.

If you know what I mean, if you have a healthy competitive system between public and private sectors, what happens is the public sectors held to account for for general performance and the private sector is the same. And so these counterbalancing forces generally result in in a healthier managerial class, I would say, as to what's you know, a Better answer than that I cannot give you, i'm afraid. So it's a difficult problem.

Like fascinating any other big ticket items because like these are all fascinating.

Not really. I mean, I think you the things we talked about the global health element having a baLance sector, we prioritizing what what does the citizens actually want? You know how much of their tax money they want go in a health care education specifically, this is other things. And understanding that we are going backwards know, and we need to be honor about that. You know.

in terms of number of beds and capacity of everything, it's also true. I feel like everything is going backwards.

Yeah maybe the case, but we have no potentially have some solutions on the horizon. So there's a reason to be slightly optimistic guds say .

it's really love to ask you.

you wish I had is a good question. Not really. I think we ve covered a lot of ground and really happy about talked about today. So thanks again .

for it's one of those ones why I like I now I need to go away and do small things and then they cover this again because i'm really interested in as a subject i'm i'm interested in because IT chAllenges the chAllenges that librarian, well, i've been have running head strong into. You ve had a lot of .

conflict about that internally. Forget about the external views, but you've gone from sort of being a bit more socialist, a bit more libitina, ian. And but I can see that both don't quite sit right, you know not not sure where belongs.

I think no, I think I think I think I figured that out. And so what is is is no what ideology is perfect, right? And uh, one of things we can get away from is that I think government is an emerging system.

You put you, you take fifty people, you stick on on island, you wait again, you record IT, they're onna create a government on at some point to make decisions. It's just emergent way of making decisions. But I can become corrupted.

Luckily, we at some point we got this single democracy, which was meant to give us, uh, uh, uh, the the, the ability to vote. Outcome obvious. Ly, governments become bloated.

I actually think the solution is with the libertarians. But IT, isn't liberalism itself extreme? No, it's a liberty an influencing government. Yes, I think what we need have an educated population understand the basics of economics um understand it's just that the basis of economic omics, how is systems work and bills to think critically. But I think the librarians who is no government, they're unhelpful because you're basically.

you've got a no idea that can never exist, is never going happen.

You typically is wrong. And I you see the libertarian ans hold the keys. If the libertarians go into government, they have go to any party and go with a strong voice.

All they have to shelton's. We have left, right, left. Or what we need is big, small, big, small rain IT in correct baLance, baLance.

And I think that comes from, uh, a strong educated articular group of liberty. Rs, get into police, no question. I, me.

i've lived in democracies and non democracies I ve to buy for a very long time. I grew up there. And I can tell you that the reason democracy works is not for, in my view, is not because of the reason people think IT works.

People think that works, as is this noble calls. But the way I see IT working Better than other systems, as i'll give you analogy of the bowling ally, you if you can hit the pins as a strike every time, that's great. But if you can't and if if the issue is too complex that you'll never be able to get the right, then putting those guards on the side where you bounce around between two thoughts, in this case, right and left door authoritarian libertinism.

That's how democrat generally works. And if you look at most democracies, they swing between right and left and between and authority, m with time, and they end up in the somewhere. And it's middle.

It's messy middle. And the messy middle is how this works, because at the other day, humans are in the messy middle. That's how we work. And so having any thought where you think that one particularly system, whether it's public health care, socialized medicine or ultra capitalist private health care or whatever system you are about, if you go to find in one direction, you will pay the Price for that in other ways. It's that simple. And so I think if we can get to a point where we accept the messy middle and understand that a healthy baLance between different ologies probably gives the best outcome for the most people, that would be a the true revolution, in my view. Rather than keep fighting over, are you on this side or that side and there there's no no middle in between that works you .

know profound and demand yeah give you a lot to think about. I really appreciate you be .

I thank you so much for giving me a platform and for no, it's a pleasure to be here. I wash your show for years. Sten is .

all learned. Okay, we should. We can get.

McDonald k, sounds good for Better. Thank you. Thank you, everybody. you.