Health care: America vs. the World

Funding for this program is provided by contributions to your PBS station from viewers like

you. Thank you. Let me feel

underneath your arms. It's a uniquely American

problem. The richest country in the world leaves tens of millions with no health

insurance. It makes me feel that we don't matter. The thing about surgical theater is

that it allows you. A country with such remarkable innovation. They don't know a discharge

date. And yet so many are struggling. Every one of us can name some people

we saw suffer the death. You know, the deck's stacked against you. This

is America's day. As a new administration takes over promising reform, we travel

to four very similar nations with four very different health systems for clues. I

love how open and explicit they are about the fact that there are always choices.

Did you have a good sleeve? How do they care for virtually everyone and do

it for less money? No one says, well, that's going to cost too much, so

we're not going to do it. Here it's a bit more humane. It's like, look,

you know, there's a basic level of care that people deserve. It costs, but you

still deserve it. And amid a pandemic, does universal coverage help save lives? If you

require an ICU stay, if you need to be intubated and ventilated, all of those

things are covered under the public system. We have a problem. What lessons can we

learn from abroad? Critical Care, America versus the World.

I'm William Brangham, and our first stop is Houston, Texas.

There, we met a little boy saved by American innovation, a bouncing,

rocking, joyful testament to the miracles of modern American medicine. His life was

transformed here, in what's called the largest medical city in the world, the Texas Medical

Center in Houston. Here, doctors test artificial organs built from scratch.

Technicians design robots to speed efficiency. Surgeons use virtual reality

reconstruction to see tumors inside the body before ever making an incision.

And kids like five-year-old Kacen Cox come back from near death.

Kason was born with only half his heart functioning normally, those hints of blue in

his skin, a sign of a little body hungry for oxygen. Most kids with this

condition don't live very long. I can remember it perfectly. It was pouring rain

outside, of course, and I was by myself and my doctor told me that

she sees that Kason's heart is underdeveloped. It was a very few dark days for

me. But using new and highly complex surgical techniques, Dr. Jorge

Salazar, that's him on the right, changed the course of Kason's life. Kason was going

to die. And had we done what we've always done, he would have had a

transplant already, or it's hard thing to say, but he would have passed away already.

But now we have a normal child in front of us. DR. JORGE SALAZAR, Dr.

Salazar came out with the biggest smile on his face, and he said, I did

it, you did it, he did it, and it worked. So, I

mean, I think we all started crying. You got it? Kaysen Cox is one story.

The Texas Medical Center performs over 180,000 surgeries every year. It,

along with other gold standard medical centers across the U.S., draw hundreds of thousands of

patients from around the world. The technologies and innovations created in the U.S. also

get exported globally. You see what your options are around here. But just a few

miles away, it's a world apart. In North Houston, the mostly low-income residents here

experience a very different health care story. I want you to see that within

just a few miles, you have the very best and the very worst.

And it's just not fair, and it doesn't have to be that way. Elaina Marks

is the president and CEO of the Episcopal Health Foundation. And last year, she took

us on a tour. Her foundation analyzed CDC data documenting widespread

disparities in this area. ELANA MARKS, Episcopal Health Foundation, Episcopal Health Foundation, Episcopal Health Foundation,

She pointed out that the mostly Black residents here are disproportionately uninsured. They

often don't get good care until it's too late. They die, on average, 20 years

earlier than residents in other parts of Houston. You know, the deck's stacked

against you. If you could get to the medical center, that would be great, but

you'd probably be really sick because of the neighborhood you live in by the time

you get there. We started filming this program last year

when China was dealing with an explosion of this mysterious new coronavirus. But at that

point, only a few travel-related cases had been found in the U.S. Still, many

residents in this part of Houston, like Ruby Glass, whom we met at her home

with her mom, knew that if the virus landed here, these disparities would hit communities

like hers the hardest. Can you imagine that if that were to hit in my

community, a lot of us don't have insurance? Where do we go? Just a show

of hands, has anyone around the table ever worried about whether you could pay a

medical bill? Glass gathered a group of people from her community to talk with us.

And we heard about the very disparities that the pandemic would exacerbate. Many in the

Black community in Houston felt the health care system wasn't on their side. You know,

from the poorest of the poor to the richest of the rich, We don't get

the same quality of care. It's kind of the implicit bias of the medical field.

Towards people who have black skin. Yes. Every one of us can name some people

we saw suffer to death. It's all greed. The pharmaceuticals, insurance companies, it's greed. The

pain sometimes is not pain from a nerve. It's pain from a broken heart, from

knowing that nobody really cares that you're suffering.

Pandemic aside, the U.S. spends about $3.8 trillion on health care every year.

It's nearly a fifth of our economy. As a percentage of GDP, that's roughly twice

what most high-income nations spend. Our total health care spending is more than all these

nations spend combined. And yet Americans still die of preventable and treatable diseases

at higher rates than in other high-income countries. Ours has been called the most expensive,

least effective healthcare system in the modern world. Lack of health insurance, or the high

cost of healthcare, is a huge barrier for millions. In a poll last year, more

than one in three people said they skipped medical treatment because of money. That includes

people with health insurance. According to the most recent data, more than 30 million Americans,

about 12 percent of people under 65, have no health insurance at all. During the

pandemic, experts estimate millions more joined their ranks. For many

years, Houston resident Lakeisha Parker was among the uninsured. She was a certified nursing

assistant. I was proud of that work. I enjoyed doing it because I love to

be able to help people. So what I would do is go into people's homes

after their surgeries or illnesses and assist them with getting back to life, daily

activities of living, bathing, fixing them a small meal. That's very intimate work with people,

right? It is, very intimate work. But Parker says the pay wasn't great. She says

the most she ever earned was about $13 an hour, and it never came with

health insurance she could afford. I'm actually working in health care and can't afford to

pay it. That's not right. How can you come to this, go and be a

help to other people, and then when you need the help, it's not available for

you. Or if it is available, it's hard to come by. So, no, that isn't

fair. Even before the pandemic, Texas had the highest

uninsured rate in the nation. Roughly 18 percent of Texans, that's over 5 million people,

didn't have insurance. And the state didn't expand Medicaid, which would insure more low-income

Texans under the Affordable Care Act. So, like many, Parker went for years

without checkups or seeing a regular doctor. Too expensive, she said. But then,

lying in bed one night, she discovered a lump the size of a tangerine in

her breast. It was malignant cancer. Parker

found this Houston clinic that would treat her on a sliding scale based on her

income. Only after the cancer diagnosis did she qualify for a special Medicaid program.

So the tumor, along with 33 lymph nodes, were removed. While surgery was a

success, It, along with the chemotherapy and radiation, left her with limited use of one

of her arms. Okay, not bad. Let me feel underneath your arm. Do you think

if you had had insurance, you would have found this sooner? You would have been

going to the doctor sooner? If I would have had insurance for me at that

time, healthcare that I would have been able to afford, I would have easily accepted

it. But again, it comes the question of having somewhere to live, having something to

eat, gas to get back and forth to work. So, you know. Those were the

choices you were wrestling with? Of course. You know, those are everyday life choices that

lot of people have to make based on their income. The weakness in her arm

cost her her job. With no money, she lost her apartment. At the time of

our interview, Parker was homeless, unemployed and living in a shelter. Houston represents both what

is the best of American health care and really what is the worst of American

health care. You have parts of Harris County, which is where Houston is, where life

expectancy is lower than what you see in many third world countries. Dr. Rashish

Jha, the dean of Brown University's School of Public Health, traveled with us for this

program. DR. RASHISH JAHA, Brown University School of Public Health, I reject that dichotomy as

somehow we have to have 20, 25 percent of people uninsured if we're going to

have a really highly innovative health care system. There are many reasons to reject that.

So take a state like Massachusetts, where I live. It's also very dynamic. Incredible new

innovations happening. And yet pretty much everybody in Massachusetts is covered. Look, innovation, there is

a cost to it. It does raise the spending of health care. That is a

reality. But we can afford to pay for that innovation and still make sure everybody's

covered. So this is the challenge for health care reform going forward. How to

preserve the high-quality care that saves the life of a boy like Kacen Cox, while

helping the tens of millions, like Lakeisha Parker, who have no health insurance at all.

Many nations around the world have already struck that balance and done so successfully. But

before we learn about those places, we traveled to Princeton, New Jersey to talk with

two of the world's top health policy experts. They'll be our occasional guides throughout this

program. One we've already met, Dr. Ashish Jha of Brown University. The

second is Tsung-Mei Cheng. She's a health policy analyst at Princeton University. She and her

husband, the late renowned health economist Uwe Reinhardt, have advised world leaders and helped design

Taiwan's universal care system. So, Ashish, why is it that we have those kinds of

disparities here in the U.S.? You know, William, we've made a bunch of political choices.

We have more than enough capacity, certainly more than enough resources to cover everybody. But

we have chosen not to do that, again, from a policy point of view. This

is not a trade-off that we have to live with. We can continue to have

the best health care and cover everybody. We just, for political reasons, we've chosen not

to do that. May, do you see it the same way that this is a

decision we have made, that we are going to be OK with a society that

looks like this? Yes. In this country, we're very different from these other

countries that have health insurance that covers everyone. Health

reformers in Europe, in Asia, they would make explicit the social ethic that

underlie that health system. We're going to establish a goal and then get there. Right,

to say, yeah, what is it that we value as a society? And so then

they build their health care system around that. But in this country, because we have

never been able to achieve a social and political majority

consensus, we live with the status quo, which is, you know, people who have insurance

get scared and those who don't, don't. And the ones without health

insurance, we know they get sicker and many of them die. Yeah, so the disparities

we see in the US has certainly driven a lot of people to look to

other countries and to look to single-payer systems, which have a bunch of advantages, right?

They cover everybody. They are administratively simpler, and they have a lot more equity potentially

built in. You have a specially ambitious plan. In the last election cycle, the Democrats

had a vigorous debate about whether to push for a single-payer Medicare for all plan.

Its champion was Senator Bernie Sanders. We are the only major country on Earth not

to guarantee health care for all people, which is why we need Medicare for all.

To look at one of the inspirations for Medicare for All, we visited one of

the world's preeminent single-payer systems in the United Kingdom. Good morning

to you. Did you have a good sleep? Even with the help of his mom,

Liam Murphy still struggles to wake up each day. I thought you would be dreaming

about Charlotte, right? Why Charlotte?

Liam has Down syndrome, epilepsy, and chronic lung disease. He's dealt with these since

the day he was born. The 10-year-old lives in Watford, England, with his parents, Gary

and Angelina, and big sister Laura. They have to be constantly vigilant for trouble. Oh,

don't start, don't start. Can you get the mask, please? Like

this seizure. No, I can't have that on, not on the... There's a cannula.

Turn it down. Dozens of times a year, episodes

like this will send Liam to the hospital. He is always at risk of dying.

Liam's life and the incredible care he gets are a testament to the United Kingdom's

National Health Service, known as the NHS. Residents of the U.K. pay taxes to the

government that support the NHS. The government is then the single payer for health care.

It pays doctors and hospitals and covers nearly all costs. Seatbelt's on. For Liam,

that's all his medicines and hospitalizations. It pays for caregivers that come several times a

week. The NHS even paid for this chair and standing frame to help him exercise.

He's been out for about half an hour now, hasn't he? So that's really good,

Liam. No one says, well, that's going to cost too much, so we're not going

to do it. You've never heard those words? No. If we call an ambulance, an

ambulance will be here in five minutes to pick Liam up and take him to

hospital. The specialist team will come out. pick him up, put him on their ventilators,

take him to intensive care. An intensive care bed will cost 2,000 pounds. No one

mentions the money. They just do what you need to do. Without the NHS, we

would be bankrupt. Liam would probably be not with us. On July 5th, the new

National Health Service starts. The National Health Service was built from the wreckage of World

War II, something of a gift from the government to a battered and impoverished nation,

which welcomed it. And today, it's still considered the U.K.'s great equalizer.

Everyone, regardless of profession or income, has access to that system, from primary care to,

as needed, the full range of specialty services. Patient's point

of entry to the system is through their general practitioner, doctors like Sam Everington. SAM

EVERINGTON, There's no cost attached to going to see a doctor in this country at

all. And that's really powerful. Do you ever think about how much things are gonna

cost when you come to the doctor? No, it doesn't cross my mind. But the

thing is, because I'm diabetic, in England, if you're diabetic, your prescriptions are free, so

I don't have to pay for it anyway, so it doesn't cross my mind. Despite

those benefits, per person, the NHS spends less than half what we spend in the

U.S., including a lot less than we do on administrative costs. And the NHS