Saum Sutaria, M.D.

So my personal belief from personal experience is that clinicians do make a lot of the choices at Kaiser. They get knocked sometimes that somehow there's a corporation sitting there telling them what to do. And yes, it is managed care. And yes, there are restrictions on, in some ways, how they construct their system. But when you have an esoteric problem,

So my personal belief from personal experience is that clinicians do make a lot of the choices at Kaiser. They get knocked sometimes that somehow there's a corporation sitting there telling them what to do. And yes, it is managed care. And yes, there are restrictions on, in some ways, how they construct their system. But when you have an esoteric problem,

No one stops a physician from sending you to the right place there, in my experience. And all systems that are in managed care have out-of-network expenditure for rare things. I think that's a really important point and worth bringing up from that perspective. But you have these systems then that work in certain places and don't work in other places that effectively.

No one stops a physician from sending you to the right place there, in my experience. And all systems that are in managed care have out-of-network expenditure for rare things. I think that's a really important point and worth bringing up from that perspective. But you have these systems then that work in certain places and don't work in other places that effectively.

The vast majority of the country today, from an employer-sponsored standpoint, is working in some form or another of a PPO system where people have choice because that's what they want. And again, that choice comes with a cost, as we've talked about, that maybe explains some of the differences between us and other countries.

The vast majority of the country today, from an employer-sponsored standpoint, is working in some form or another of a PPO system where people have choice because that's what they want. And again, that choice comes with a cost, as we've talked about, that maybe explains some of the differences between us and other countries.

Well, I think you have to be careful about that. You're paying- You're paying for it, of course, through your taxes.

Well, I think you have to be careful about that. You're paying- You're paying for it, of course, through your taxes.

I think there are excellent physicians around the world and developed countries all over the place. There's no question about that. I would tend to agree with your description of the top physicians in both places. I would draw one distinction, which is I think emergency care is accessible everywhere. on an emergent, immediate basis in most developed countries.

I think there are excellent physicians around the world and developed countries all over the place. There's no question about that. I would tend to agree with your description of the top physicians in both places. I would draw one distinction, which is I think emergency care is accessible everywhere. on an emergent, immediate basis in most developed countries.

Now, the interventions that they may take, how interventional it may be, how aggressive they may be using the most modern technologies or modern devices or whatever may be different. But emergency care is available. If you had a heart attack immediately in Canada, went to the emergency room, you're going to get treated very well. I think where things change is the elective care.

Now, the interventions that they may take, how interventional it may be, how aggressive they may be using the most modern technologies or modern devices or whatever may be different. But emergency care is available. If you had a heart attack immediately in Canada, went to the emergency room, you're going to get treated very well. I think where things change is the elective care.

And by the way, heart surgery can be an elective. You might think of elective as cosmetic surgery. No. A hip replacement, a knee replacement when you can't walk, a cataract replacement when you're half blind, or heart surgery can be elective. You're just scheduling it in advance. And you're absolutely right. In many parts of the world, the wait times for those things are much longer.

And by the way, heart surgery can be an elective. You might think of elective as cosmetic surgery. No. A hip replacement, a knee replacement when you can't walk, a cataract replacement when you're half blind, or heart surgery can be elective. You're just scheduling it in advance. And you're absolutely right. In many parts of the world, the wait times for those things are much longer.

The cynical view of that is, of course, that it's a cost management system. But what I would say is they've made a choice.

The cynical view of that is, of course, that it's a cost management system. But what I would say is they've made a choice.

It's an infrastructure choice. So the way you would describe this in economic terms is that you have universal coverage, which creates the same moral hazard problem that we described here. People would consume infinitely, but they choose to cap it with supply side interventions, constricting the supply or available supply of services in order to manage the demand. And what does that do?

It's an infrastructure choice. So the way you would describe this in economic terms is that you have universal coverage, which creates the same moral hazard problem that we described here. People would consume infinitely, but they choose to cap it with supply side interventions, constricting the supply or available supply of services in order to manage the demand. And what does that do?

It creates wait times, right? Or accessibility problems. And you have a lot of Canadians who come into the US for healthcare on a more immediate basis, or they buy private insurance, which can reduce the wait times from that perspective if they can afford it. I mean,

It creates wait times, right? Or accessibility problems. And you have a lot of Canadians who come into the US for healthcare on a more immediate basis, or they buy private insurance, which can reduce the wait times from that perspective if they can afford it. I mean,