49. How to fix a broken system: American healthcare in crisis

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1:15Welcome to The Rest is Politics US with me, Katty Kay. And I'm Anthony Scaramucci. Welcome, Katty. You look like you're in an undisclosed location. No, it's a fairly disclosed one, actually. I'm sitting here in Abu Dhabi on El Ariana Island. I just finished the Abu Dhabi Finance Week. Super fast growing city, beautiful city, actually. And I talked about all things crypto, Katty. You know, we don't talk about crypto. I bet you did. We should talk. On the rest is politics, US. Maybe we should do a whole crypto episode because it's becoming intensely political. But we're not here to talk about that.

1:49What are we talking about today, Katty Kay? Okay, so before we get to what we're going to talk about today, I first lived in the UAE in the late 1960s. And I can tell you there was not a lot of crypto hanging around back then. There were silver dollars. Oil was just starting, but there was not a lot of crypto. Okay. So today we're going to do something a little bit different. We're going to take a bit of a break from Donald Trump, although we'll give you a short update on where the nomination process is. But we're going to talk about this story that has been all over America and the American media this week, and that is the assassination of a healthcare chief executive outside a conference in broad daylight in Manhattan, the manhunt that took place.

2:35And then what happened online, which was this huge outpouring of understanding for the shooter and fury at the American healthcare industry. Are we getting into a period of political violence in America? And is this a period of reckoning for a healthcare industry that no one seems to like very much and that costs America far more than any other country in the world is paying for their healthcare? I think this is a kind of sleeper story that sort of exploded over the last three days here, but tells us something about how angry people are at the state of life in America. And then in the second half, we're going to do a quick update on those nominations.

3:19And we are also going to look at Syria. I know that Alistair and Rory have done a lot on Syria this week, and they've done it so well. I listened to their live stream, then they did a special breaking news episode on Syria, which was great. We're going to look at it more from the American perspective, historically, of course, Obama's famous red line. We're going to explain what that was, what that meant for Obama's legacy, what it meant for American power in the region, and what the understanding is today of American influence in the region. And something I want to talk about, which is the surprising kind of bipartisanship between Donald Trump and Joe Biden this week around Syria.

4:02So we will talk about that in the second half. But first, Let's kick off with this story that took place in New York and a quick update. On Wednesday, the 4th of December, so about 10 days ago, the head of the United Healthcare Group, Brian Thompson, was up in New York for the annual investors meeting for United Healthcare. and as he walked from his hotel room to the Hilton where the investors were gathering, as he arrived at 6.40 for that meeting, a masked gunman approached him from behind. The video is extraordinary. I'm sure many of you have seen it and shot him several times. Afterwards, the police found that on the shell casing, the words deny, defend and depose had been written in Sharpie pen.

4:56Now, those are words that are often used by healthcare companies when they are going to deny your insurance claims. And so the assumption was that this was a killing that was related to the health insurance industry. On Monday, the 9th of December, police arrested a young man called Luigi Mangioni in Pennsylvania. He was in a McDonald's and a McDonald's employee was suspicious of him and called the police. The police came and when they asked him if he'd been in New York recently, he started shaking and he was charged with Thompson's murder the following day. He is also carrying multiple fraudulent IDs, a 3D printed gun, a silencer that were believed to be consistent with the weapons used in the attack, and perhaps most critically, a three-page written manifesto attacking the healthcare industry.

5:50And I think what is interesting about this killing, I mean, it's tragic. Brian Thompson had two kids, a family, they have lost their dad. And this does smack of kind of vigilante justice. And I don't know if that is where the country is headed at the moment, but there was just an enormous amount of online sympathy for this young man, Luigi Mangione, not just sympathy for his particular case, but for people who feel incredibly frustrated with the state of their healthcare. So let's talk a little bit about how dire the healthcare industry is for ordinary Americans trying to get treatment and trying to get reimbursements.

6:30Healthcare in the US, it was a very capitalist system after the end of the Second World War. You'll have to tell me when the healthcare services came into place for the United Kingdom, but I believe it was right after the Second World War. Harry Truman wants it. He wants to put it in place for the US. He wants to nationalize the healthcare systems, a similar NHS, if you will. He's pushed very hard by the Republicans. And I just want to point out to people that the Republicans lost the plot from 1932 to 1952. So there was a 20-year reign of Democrats in the executive branch, FDR and Harry Truman, 20 years.

7:14And so the Republicans went very hard at this. It's very important to understand this because they were backed by the American Medical Association. And remember, this is a time in America where doctors were exalted, a very different time in America culturally. And the doctor said, hey, I went through all the schooling and did all this work. I deserve to make my economic rent off the patients in a capitalist system. And so the Republicans won that argument. We never got the National Healthcare Service in place for everyone. But in 1965, we did get Medicare pushed through and Medicaid, which was a form of national health for the very indigent.

7:58So in the middle, Caddy, is the insurance system. Okay, it's very important to understand this. You get your insurance in the United States mostly from your employer. If you've got to go out and get it on your own, you typically pay more. Why is that? Well, you're a one person. These insurance people like to price things on a big pool of people. And so a firm that has 50 ,000 people, person rate is lower, the monthly or the annual rate. But if you're one person, it's going to be way higher because of the way statistics work. This is very, very important. Now, fast forward, Barack Obama, he comes into office, he wants to promulgate Obamacare, which is effectively making every insurance company come up with an insurance policy that's affordable, i.e.

8:50the Affordable Healthcare Act, which is exactly what it was called, But then it was derisively called Obamacare by the Republicans. They thought that was going to be a bad word. It turned out that the Americans generally want this health care. They want this universality of health care. So Obamacare became a positive as opposed to a pejorative. And by the way, Obama tried to have what we have in Britain, right? At one point, one of the discussions when he came in and said, I'm going to do reform health care was to do what the Brits did or what the Canadians do. And Sarah Palin almost single-handedly killed it by saying, oh, they're going to have death panels deciding who lives and dies.

9:31That is what happens in countries with public health systems because there isn't enough healthcare to go around. That is not true. They do not have that kind of death panels. But anyway. That's an important part of this story because there was a Senate seat that opened up. One of the real champions of universal healthcare or national health service was Ted Kennedy. This was the third son. There were four sons. One died in the war, but the three that became politically active, John, Bobby, and Ted Kennedy. Ted Kennedy, the great senator from Massachusetts, the great lion of the Senate, he championed for five decades getting a healthcare act done.

10:12But unfortunately, he died in 2009 of a brain tumor. Now, the attorney general, I should say, from Massachusetts came in. Her name was Martha Coakley, and she was running against a Republican in one of the bluest states, the most Democratic states in our union, Massachusetts. This is a former classmate of mine from Tufts. His name was Scott Brown. That death panel story fed into that campaign and Scott Brown beat Martha Coakley and you had a Republican take over this legendary five decade seat of the Kennedys, John and Ted Kennedy. And he moved into Teddy Kennedy's office and he voted down the Obamacare that you're describing, the one that would have created this national health service.

11:03So they modified it and they did something that they call reconciliation. And they created what is now known as the Affordable Care Act. So put simply, you're in the US, you can't really afford healthcare. Maybe you're not working for somebody. Maybe you're unemployed. You have to get a mandated insurance policy from somewhere in the system. And so what did the system do? It got forced on them, right? So this is not a free market. This is forced on them. So what did the system do? They've got to pull from somewhere and they start pulling from people. They deny your prescription. They deny your operation.

11:43They deny your MRI. They increase your premiums. You go to pay for your cholesterol medication and they say, geez, I'm sorry. You now have a$300 deductible and it's going to cost you$300 before the insurance comes in. Or you have a surgery. I had my shoulder repaired and the hospital sent me a$30 ,000 bill. I said, excuse me? Oh yes, you have a$30 ,000 bill. Your insurance company only paid$25 ,000 of it and you've got to pay the remaining$30 ,000 and then you have to fight it out with the insurance company to see if they can give you money back. This is why people are so mad because everybody has one of these stories.

12:26I have UnitedHealthcare. My system works brilliantly most of the time. But about four years ago, I needed an MRI. And that MRI has still not been resolved. I still get bills from the MRI company every single month. And UnitedHealthcare says, well, we're not paying it. We're not paying it. We're not paying it. And don't you pay it either, because eventually they'll realize that no one's going to pay it. I think, you know, Anthony, you and I, educated, employed, persistent, We know how to work the system. Imagine if you're not those things. Imagine if you're somebody who doesn't have the benefits that we have, who doesn't have the advocacy that we have.

13:06I can understand why people are absolutely furious. There's a story about a woman who was told by her doctor her baby was in the hospital. They needed to transport that baby to another hospital. They summoned an air ambulance, but her insurance wouldn't pay for the air ambulance. She didn't have the money to pay for the air ambulance herself out of pocket right there, but they said her baby was in a life-threatening condition. It is breaking this country. It's breaking the country at the moment. It's heartbreaking on so many different levels. And this is another part of this story that I think you'll enjoy and so will our listeners.

13:43Ronald Reagan was a right-leaning conservative politician. And when this issue came before him, he was vexed by it because Reagan would say privately, wow, we're a rich country. Healthcare is about creating equal opportunity. I am as a conservative, I'm now channeling Reagan. I as a conservative want there to be equal opportunity. I'm not for equal outcomes. That's Marxian and that's too socialist for me, but we've got to get people to the starting block and we got to get people with a base level of healthcare, particularly young people with a base level of healthcare. And in 1986, buried in some legislation, they always bury in some light items into legislation.

14:28He created universal healthcare in the United States. And so let me explain to you what he did. It's very important. If you walk into a emergency room, let's say you're indigent, let's say you're an illegal alien, let's say you're the poorest person in America, but you walk into the emergency room and you have an ailment, they are legally obligated as a hospital in America to treat you. And if you don't have insurance, well, that goes on the balance sheet of the hospital. But do you know why that's insane? It costs about 10 times more to treat you for a minor ailment. If you had a healthcare system that provided primary healthcare for everybody and preventative medicine for everybody and checkups for everybody where you could call your doctor and go for your strep throat, it would treat you at a fraction of the cost.

15:20And that's another way the system is broken. I mean, this idea that it is free choice and Sarah Palin's idea, well, if we have a national healthcare system, it's going to have death panels. And I look at the UK health system and that is broken too. I know less about Canada. It seems to me that the healthcare systems that work best in the world are one that are a mixture of public and private. So Germany, Japan, Switzerland, people seem to have pretty high levels of satisfaction with their healthcare systems. The difference is in those countries, in Germany, for example, the health insurance companies aren't allowed to make large profits.

15:58And if you look at a company like United Health Group, which is the company that this chief executive worked for, it reported$22 billion dollars in profits in 2023. So I think that's part of the problem, right? That healthcare insurance companies are making huge profits and the profits keep growing, but the quality of service keeps declining and nobody seems to keep a check on it in a way that is both efficient for the system, so people are not ending up in the ER, getting treated for a strep throat, and gives people customer satisfaction. As you and I both know, there's no call for this type of violence, this type of senseless violence.

16:44Yeah, I agree. But what I find interesting about our society right now, have we become so callous? Meaning, if you're anonymous on X or anonymous on Instagram, you can write these bullying screeds. You can cyber bully people. You can dehumanize people. You can take them apart every which way possible. And is it now spilling over into real life where you have a combination of people playing video game after video game, shooting and shooting and shooting people? Silencers are quite popular in video games. You know, like detectives said, this was definitely an amateur. And I said, excuse me, why do you say that?

17:25He had a silencer. He goes, oh no, a silencer is a sign that he's an amateur. he plays video games. Interesting. A professional would have wanted a very loud shot. Really? Why would he want a loud shot? Wouldn't that cause everybody to look at the shooter? He said, oh, no, no, it's the very opposite. You hear bang, bang, you're ducking and running and the shooter gets away scot-free. No one remembers the shooter as they're seeking safety. And so a detective said to me, and I remember going home and talking to my wife Deirdre about it. I say, why is that detective saying this? I didn't understand.

18:01It was on TV. So I called one of the local detectives and he responded and told me, no, no, that kid is a video game player that shot him because they always put the silence on in a video game. But my question to you, Caddy, is the senseless cyber bullying, combined with the video games, combined with the trauma and frustration, is that mixture so toxic that it spills over into senseless shootings in a street in New York City? I think there's lots of different bits there, and each one needs to be kind of treated separately and analyzed separately. And I think that some ways in which social media actually around this killing, I deplore the lack of sympathy for the man and his children and his wife and his family.

18:50I don't understand how people can feel so callous, even if, yes, he worked for a healthcare company that was making a lot of money and at the same time is literally bankrupting people. I understand that anger. And United Healthcare, by the way, turns down 32 % of all claims, which is twice the industry average of 16%. So United Healthcare is particularly egregious, which may be why it was him that was targeted. And I think you can separate those feelings out from this. And I think it's good to get the information out there. I think it's good the way that the social media is allowing some of this information to get out there.

19:28Again, some of it may be unreliable and some of it may be reliable, but it's worrying to me that people, if we are in an era where people start feeling they can take the law into their own hands and justice into their own hands. Look, this may be a total one-off, but are we in a moment in time, and you and I are recording a whole January the 6th series at the moment, where those people clearly felt justified in going down to Capitol Hill and taking the law into their own hands and smashing up the Capitol. This guy clearly felt justified in shooting somebody in broad daylight in the street. So, Cady, everything you just said makes sense, but tell me where we've lost our touch with each other.

20:11And what I mean by that, that man had a family. And so have we lost our touch? Is there something going on psychologically in our communities where we now see each other as objects in our field of vision, as opposed to human beings? And again, not to throw stoicism into our podcast, but I just want you to think of the word sonder for a second, S-O-N-D-E-R. This word for the Stoics mean that you have your life and it's super important to you and you have your ecosystem around you and I have mine. But if you can get to the word Sonder, you understand that everybody that you come in contact with has that.

20:55They have an important thing going on in their day. They have children that they're trying to take care of, or perhaps elderly parents or they're younger thinking about their sports team. And when you can get to the word sonder, you start to appreciate that, yes, your life is important, but it's not necessarily more or less important than other lives. But we're now in this sort of narcissistic playground where what's happening to us matters maybe more than the people around us, where I'm a grieve, You've chipped me in the insurance system, a result of which there's going to be hell to pay and a murder of the CEO of the insurance carrier.

21:38Is that where we are in our society? Is that really where we are? Is that where we're going? Because it's not necessarily just a one-off because the reaction caddy was so overwhelmingly sympathetic to the shooter. That's what was interesting. It makes me say, well, wait a minute. Have you guys lost the sonder? Have you lost the ability to appreciate each other? And have you lost the ability to recognize, yes, you're important, but other people see themselves as important as you see yourself? I mean, part of the reaction was, I think, understandable fury and outrage and pain at the state of the health insurance industry, which I think is actually legitimate and needs to be talked about.

22:21And it would be extraordinary and beneficial, I think, to America. I mean, God, it would be beneficial to America's national debt if nothing else. And that's probably the least of it if America spent less on its health insurance and improved the quality of its delivery of healthcare for people. But I think what you're talking about reminds me more of something that Vivek Murthy, who's the Surgeon General of the United States, has been talking about for the last year or so. And that is an epidemic of loneliness and isolation in this country. And he has warned that about half of all American adults are experiencing considerable levels of loneliness that are affecting their physical health, their mental health, and their societal health.

23:07In other words, their ability to be out in society. And I know it's when somebody like that comes up, I mean, I hope that people do listen when somebody like that comes up with a report. And I've just been so impressed with the way that Dr. Murphy has really been trying to ring the bell on this one, on a subject that is not sort of tough and sexy and about power or money, but is something that affects an awful lot of people. I don't know when it started, but what the consequences of that loneliness might be, I think we're starting to find out. And I think some of what you're talking about is behind this story.

23:45We are going to take a break and come back, having had that very soulful discussion on The Rest is Politics US, talk a little bit of Trump because we can't totally drop our favorite character in this drama. So we'll take a break and we'll be right back.

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25:45Okay, welcome back to The Rest is Politics US with me, Katty Kay. I'm Anthony Scarwish. Last time we spoke to people, Anthony, last week, I think we may have given the impression that Pete Hegseth was going to be gone by the end of the weekend. And he seems to be still hanging on. He's still going around Capitol Hill, still desperately trying to convince senators to vote for him in the committee hearings that will start next January. How do you rate his chances at the moment? So, you know, I've been wrong. I would have thought he would be gone. Listen, I talked to these senators. Yeah, we both thought he was going to be gone.

26:22I think it's important for people to understand that you and I have good sources, or at least I think I have good sources. I have friends of mine that I've donated money to for multiple decades, and I don't think they're telling me what I want to hear because I don't have a dog in the race with Pete Hexed. He becomes the defense secretary. I wish him well. I don't have a dog in the race. Kash Patel is a different story. I think he's an incredibly dangerous person, and if he just does 10 % of what he's saying he's going to do, forget about hurting the American civilization and me and my fellow citizens.