Coronavirus in Context: Which Country Has the Best Health Care?

[MUSIC PLAYING] You're watching Coronavirus in Context. I'm Dr. John Whyte, chief medical officer at WebMD. How do you feel about your health care? Is it good? Is it bad? A lot of people will say we have the best health care in the world, if you have insurance. And what has COVID taught us about the realities of how we deliver care in the United States? To help provide some insight, I've asked William Brangham. He's the host of a new series at PBS NewsHour called The Best America and the World. William, thanks for joining me.

Doctor, very nice to see you. Happy to be here.

Now, you started filming this series pre-COVID to really provide insight-- you-- you have this great line where you talk about we have tremendous innovation in the United States, yet we also have these significant disparities in who receives health. So tell us the status of health care in the United States.

Well, just as you say, we set out to do this before the pandemic disrupted everything about our jobs and our lives and all of-- all of those things that we have been living through the past six months or so. The-- the whole idea for the series was to look at American health care, and it's the best parts of it and the worst parts of it, and then go to three other nations that are able to do certain things better than we can do, principally, are able to find a way to provide universal health care for all their citizens.

And so the idea was this was going to be a big debate going on in the Democratic primaries. Remember, this was back in January and February when we started filming this. And so we thought let's do a-- a portrait of American health care. We went to Houston, Texas for that. And in some ways, I think Houston, and Texas, uh, more broadly, is emblematic of American health care. Houston, Texas is home to the Texas Medical Center, which is one of the great medical hubs in America. And just a few miles away from the Texas Medical Center are census tracts, are neighborhoods, largely poor, in this case largely Black neighborhoods, where people in those neighborhoods die 20 years earlier, on average, than people just a few miles away.

But we don't have to go to Houston to see that, William. We see that in Boston, where you can't spit and not hit a teaching hospital. We see that in Philadelphia. We see it--

Right.

--in-- here in the nation's capital, where you and I are. Um--

Right.

--how does that compare to, say, the UK or Australia or Switzerland, some of those countries that you visited?

Well, that's the interesting thing, is that we thought, OK, let's pick countries that are similarly developed-- again, they're not nearly as big as we are, they're not, generally speaking, as wealthy as we are, but how is it that they do what we can't do? So we went to the UK, as you say, and Switzerland and Australia, all three nations that do achieve universal health care. They do it without bankrupting their countries, and they do it in a way that provides a system that, generally speaking, is overwhelmingly beloved by the people in those countries.

They also get better outcomes than we do. This is the incredible thing, is that they spend less per person in each of those three countries and they get better health outcomes in general, like people live longer or they don't suffer from chronic diseases as much, they die at much lower rates than we do from things that are preventable. So we tried to look at a sort of a comparison of, well, what do we do great and what do we fall down on, and how did these three other nations do it.

The interesting thing is those three nations-- and we chose them very specifically-- they get to universal health care through very different means. Everyone knows the UK, the famous National Health Service. It's a single payer system. You get taxed fairly heavily, and the government then pays all the doctors and all the hospitals. Switzerland does it in the exact opposite way. It's very similar to the US instance. It's 100% private insurance. There is no governmental role in providing health care or any of that. It's all private insurers. Australia is a bit of a hybrid. They have a public system that is paid for by taxes, but overlaid with that, almost half the country uses private insurance.

So we sort of looked at the mechanics of each of those nations to say, OK, they're achieving these results that we all say we want. We want everyone to have good access to health care. How did they do it? Let's look what we might learn from them.

What surprised you?

WILLIAM BRANGHAM: I have listened for many, many years to the health care debate in this country, and it's always presented as if, well, if you want to cover everyone, or go to Canada or go to America-- go to the UK, you're going to be waiting in line forever. People are going to be agonizing, waiting for surgery, and people are going to be fleeing the nation trying to get better health care elsewhere.

That's not necessarily the case. There are some examples of longer wait lists in the UK and in Canada, but the myths that we have been told that there is a trade-off between America's innovation and caring for everybody is really not true. That was the biggest revelation to me, is that these other nations that share our values and share our sense of culture and all of those things, they can do it, and they can do it successfully. So what might we learn?

Well, I also want to bring into context, uh, the elephant in the room, coronavirus, and-- and see how what you've learned perhaps is influencing what the response has been, you know, particularly in these different countries. You've talked about how people view health and the role of prevention. Um, the role of prevention and the focus on prevention is-- is very different in these countries than it is in the United States. Is that correct?

Yeah, that's exactly right. And each of those three nations, if you simply look at the number of cases, the number of people who are dying per capita, they're doing much better than we are with regards to coronavirus. It's-- it's pretty clear. The UK suffered really the worst. They had the hardest outbreak. And they've since rebounded and have done better. But none of their responses guarantee that the virus has gone away. They're still wrestling with the same virus, and they're doing better than we are not with better medicines or smarter doctors or-- they just simply mounted, uh, a more consistent public health response.

Was it through testing? Was it through messaging? What-- what did Australia do, in your mind, that was, you know, so different that it resulted in a better outcome? You know, what-- what can we learn from, you know, their-- their interventions?

Australia in particular, they did a very good job on testing. They really ramped up testing early and got it out to the public, so they could really keep their eye on the spread of the virus. And when cases broke out, they were able to zoom in on that, isolate those people, and try to put out those smaller fires before they became more widespread.

Scientists were the principal drivers of their policy. They were the people who were speaking to the public about why they are doing these things, why they're asking people to wear masks, why they're asking people to not go to work, why they're asking people to take these, again, uh, understandably hard economic pain initially to put this fire out. They did that, and they got great compliance. I think consistent messaging across the board was something all three of these nations shared, a science-driven approach.

Um, there's also-- and I think this is interesting, especially in Switzerland-- you touched on this before, John-- the-- the view that people in these nations have towards their government, especially their public health officials, it's not a politicized thing. I mean, Switzerland did not enact a terribly aggressive lockdown measure, but if you look at the compliance as it was tracked by, you know, cell phone data of how far people were driving away from their homes, the government sort of said, we need you to stay home, please try to do this, the Swiss did it unbelievably well. They just said, the government is saying we need to do this to control the virus, we will do this. Now--

So why is it different here?

We are a big, fractious nation. We have different political opinions. We have vigorous debates about these things. I mean, also we have conspiracy theories. We have people who are-- are telling others to not believe, that Anthony Fauci is somehow out to undo this country, not to try to help heal this country.

So we have the-- we run the spectrum of healthy skepticism towards institutions and questioning and a vigorous debate, but we also tend towards-- I think many would look at our response and say we've-- we've-- we've taken that skepticism a little bit too far, that-- that-- I-- I don't think there is any evidence that public health officials are trying to control us by asking us to wear a mask or trying to control our lives by asking us to stay home and keep our distance from people. And so I think that has been, in some ways, our undoing. It's one of the great things that makes America America, this rigorous, vigorous debate that we have. It-- it sometimes has gone too far, I would argue.

You've touched upon in this show about this issue of whether, you know, health care is a human right. And you also address this issue of disparity. We're seeing it front and center with the impact of COVID on minority populations, marginalized populations, sometimes six times the death rate. It's not just access to the health care system. We all know that. It's those social determinants of health-- access to fresh fruits and vegetables, walking paths, um, you know, other aspects of-- of their total health. How fair is it, people could say, you know, to-- to make these comparisons [INAUDIBLE] amongst the different countries?

Well, we set out initially-- again, all pre-pandemic-- to simply look at this issue of universal health care. How is it that they do that which we cannot seem to do? Why do we have 30 million Americans, nearly 10% of our population, uninsured and-- and reluctant to get care because it costs too much? How did those nations tackle that?

With regards to COVID, I think as you're-- as you're pointing out, there's a lot of other factors that make the disparities we have with regards to coronavirus, things that you exactly touched on. The people who tend to be uninsured in this country, poorer, minority Americans principally, are also the people who are putting themselves professionally in the jobs that make them most likely to get sick. They don't have the luxury of working like we do in our homes.

And so again-- that's, in some ways, apart from our health care system more broadly. I do think there is a way in which our health care system has complicated our-- our coronavirus response. And it's simply that I-- I think the recent polling shows that a third of Americans have said that they avoided some medical treatment because they were worried about the cost.

If that is in your mind and you come down with a fever, you start having a dry cough, you've seen on the news that these might be symptoms of the coronavirus, if you are concerned about getting hit with a bill, especially when you're not sure if your job is going to stick around till next week, that fear, that reluctance to go and get care, which is crucial for our public health response, that directly affects our ability to respond if people are afraid to go to the doctor, are afraid to go to get to a test, because they don't know if they're going to get knocked with a big bill. And that, I think, is one of the central ways in which our inability to cover everyone has complicated our response. I would say there's no doubt about that.

But in fairness, that was also very much pre-COVID, you know, during this COVID pandemic, health institutions, systems also told patients, don't come into the emergency room, you know, don't just come to the doctor's office--

Right.

--be sure to call. So they were fearful also, you know, of catching COVID-19, as well.

Right.

I mean, now we're trying to tell people to come back because we know, you know, preventive services are-- are way down, in terms of colonoscopies and mammograms. How is COVID-19 permanently changing the way we deliver health or view health here in the United States compared to the rest of the world?

Compared to the rest of the world, I'm not sure. I-- I would say that the--

Are they changing? Do you think it changed there, as well?

I think--

[INAUDIBLE]

--well, the things that I would point to that I think will change in American medicine-- and again, this is simply from talking to a lot of doctors and practitioners through the course of my reporting-- I think we have suddenly put telehealth on warp speed. And people are recognizing that you can get-- I mean, I've had now several doctors visits purely the way you and I are talking right here. As soon as we can develop the technology for, you know, better diagnostics, blood pressure, whatever-- whatever my doctor needs to know from me that they can't get this way, as long as we can start to transmit that, I think that will be a big leap forward.

I would hope that the-- the focus on hygiene, the basics of handwashing, distancing when you're sick, that-- there's-- there's the belief that some of the things that we are putting in place for COVID might, in fact, help us avoid a more severe flu season. Those types of things would be great. If people become more cognizant of the fact that, you know what, I'm feeling these symptoms, I'm not sure if it's a cold, I'm not sure if it's the flu, but maybe there's something I ought to do-- again, it requires the luxury of not getting fired from your job if you need to take a day off, but I think those things will change.

Where can viewers learn more about your series? They can find many of the episodes that have already been done?

Yeah, the whole series is now at pbs.org/newshour. That's the PBS NewsHour website. And at the very top, they'll see a little banner, a little green and red, uh, uh, uh, medical sign at the top. And the name of the series is right there, The Best Health Care. And you can click on that, and you can see all the stories we did, a lot of interactive features, polls. But all the stories are listed right there at the top of the NewsHour's website.

Thank you for taking the time to do this type of reporting to help shed, you know, some light in-- in terms of where the system is doing well and-- and where it is failing, uh, many of our citizens.

Dr. Whyte, very nice to meet you. Thank you so much for having me on.

And thank you for watching Coronavirus in Context.